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Sample records for anestesia local intraarticular

  1. Anestesia raquídea versus anestesia intrarticular en cirugía artroscópica de rodilla. [Spinal anesthesia versus intra-articular anesthesia in arthroscopic surgery of the knee.

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    Lucas Daniel Marangoni

    2016-11-01

      Discusión Conclusión: Las  ventajas encontradas a favor de la anestesia intraarticular fueron: Estadías hospitalarias acortadas, se evitaron efectos indeseables de la anestesia raquídea: bloqueo motor, nauseas, vómitos, hipotensión, pérdida transitoria de esfínter urinario y retención urinaria (globo vesical. Disminución de los costos y mayor aceptación de los pacientes.

  2. Toracoscopia diagnóstica com anestesia local: metodologia e aplicações

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    Luís Rocha

    1998-01-01

    Full Text Available RESUMO: A toracoscopia assume cada vez mais um papel importante no diagnóstico e terapêutica de muitos doentes com derrames pleurais recidivantes. É um método simples e bern tolerado, com elevado valor diagnóstico, permitindo uma intervenção mais precoce. Além do diagnóstico permite controlar derrames pleurais recidivantes e malignos, o que poderá complementarmente ter importância de ordem clínica no tratamento e melboria da qualidade de vida do doente. Apesar do número de complicações reduzido e da sua pequena importância, pensamos que se trata de uma técnica a indicar em base individual, tendo em conta o risco/beneficio. Os autores abordam a técnica e metodologia utilizada na toracoscopia, suas contra-indicações, complicações e indicações, fazendo uma revisão teórica dos resultados descritos na literatura e realçando a modalidade anestésica que utilizam: a anestesia local com ajuda de pré-medicação. SUMMARY: Diagnostic thoracoscopy and sometimes therapeutic, assumes an important role in the etiology and symptoms relief of many patients with recurrent pleural effusions. It's a simple and well tolerable method, with high diagnostic yield, that contributes to an earlier intervention. It can control malignant and recurrent pleural effusions, which will have an important role in the treatment and quality of the patient's life. In spite of the number of complications being small and of lack of importance, we think that the use of thoracoscopy is to be decided in an Individual basis, weighting risks and benefits. The authors summarise the technique and methodology, their contraindications, complications and indications, reviewing some published results, emphasising the anaesthesia method and some information supporting local anaesthesia with pré-medication. Key-Words: Thoracoscopy, Local anaesthesia, Pleural effusion, Pleurodesis, Talc poudrage, Palavras-chave: Toracoscopia, Anestesia local, Derrame pleural, Pleurodese

  3. Procedimentos cirúrgicos em pacientes proctológicos selecionados, sob anestesia local: estudo de 150 casos

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    HENRIQUES Alexandre Cruz

    2000-01-01

    Full Text Available Experiência no tratamento de 150 pacientes portadores de afecções anorretais e da região sacrococcígea operados sob anestesia local no Hospital de Ensino da Faculdade de Medicina do ABC, São Bernardo do Campo, SP, no período de março de 1995 a março de 1998. Descrevem a técnica anestésica empregada, operações realizadas e a tolerância ao procedimento. A morbidade intra-operatória foi de 10,6% (16 pacientes e a pós-operatória de 6% (9 pacientes. A idade dos pacientes variou entre 15 e 92 anos de idade, com média de 42 anos; 58% eram do sexo masculino e 42% feminino. O tempo médio de cirurgia foi de 45 minutos e o de permanência hospitalar foi de 8 horas. Todos os pacientes foram orientados sobre a técnica anestésica, suas vantagens e desvantagens, e somente após sua aprovação, a cirurgia era programada. Internação hospitalar foi necessária em cinco pacientes (3,3%. Em nenhum caso foi necessário modificar a técnica anestésica. Interrogados, 96,7% dos pacientes afirmaram não sentir dor durante a operação e que repetiriam o procedimento. Conclui-se que o tratamento cirúrgico das afecções orificiais e da região sacrococcígea com anestesia local além de viável e seguro, é bem aceito pelos pacientes.

  4. Efeitos cardiovasculares da anestesia local com vasoconstritor durante exodontia em coronariopatas Cardiovascular effects of local anesthesia with vasoconstrictor during dental extraction in coronary patients

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    Valeria C. L. S. Conrado

    2007-05-01

    Full Text Available OBJETIVO: Avaliar a ocorrência de variáveis detectoras de isquemia miocárdica, durante ou após o tratamento odontológico, sob anestesia com vasoconstritor (adrenalina. MÉTODOS: Foram incluídos 54 pacientes coronariopatas submetidos a exodontia sob anestesia local com ou sem vasoconstritor, divididos em dois grupos (sorteio por envelope: grupo I, composto por 27 que receberam anestésico com vasoconstritor; e grupo II, composto por 27 que receberam anestésico sem vasoconstritor. Todos os pacientes foram submetidos a monitoração eletrocardiográfica com Holter por 24 horas, a Doppler-ecocardiografia realizada antes e após intervenção odontológica, e a dosagem dos marcadores bioquímicos antes e 24 horas após a exodontia (creatina cinase fração MB [CK-MB] massa, CK-MB atividade e troponina T. A freqüência cardíaca e a pressão arterial nas fases pré-anestesia, pós-anestesia e pós-exodontia também foram aferidas. A Doppler-ecocardiografia teve como objetivo avaliar a contratilidade segmentar do ventrículo esquerdo e a eventual ocorrência de insuficiência mitral. Em todos os casos foi mantido o protocolo farmacológico habitual prescrito pelo cardiologista. RESULTADOS: Três pacientes do grupo I apresentaram depressão do segmento ST (1,0 mm durante a aplicação da anestesia, dois outros pacientes do mesmo grupo tiveram elevação da CK-MB massa, e em nenhum caso foi verificada presença de isquemia avaliada pelos demais métodos. Não houve registro, neste estudo, de precordialgia, arritmias e ocorrência ou agravamento de hipocontratilidade segmentar do ventrículo esquerdo ou insuficiência mitral. CONCLUSÃO: A exodontia praticada sob uso de anestesia com adrenalina 1:100.000 não implica riscos isquêmicos adicionais quando realizada com boa técnica anestésica e manutenção do tratamento farmacológico prescrito pelo cardiologista.OBJECTIVE: To evaluate the occurrence of variables detecting myocardial ischemia

  5. Herniorrafia inguinal em crianças: valor da anestesia local associada Inguinal hernia repair in children: importance of local anesthesia association

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    José Guilherme Minossi

    2002-07-01

    Full Text Available OBJETIVO: Descrever uma técnica de anestesia local no tratamento de hérnias inguinais em crianças. MÉTODO: Foram operadas 48 crianças com hérnias inguinais sob anestesia local na Santa Casa de Misericórdia de Cerqueira César, SP, sendo 34 do sexo masculino e 14 do sexo feminino, com idades entre 3 meses e 12 anos. Apenas quatro crianças tinham hérnia bilateral. A anestesia local foi realizada com lidocaína a 1% na dose de 5 mg/kg de peso através do bloqueio dos nervos abdominogenitais próximos à espinha ilíaca ântero-superior, à altura do anel inguinal externo e na pele ao redor da incisão. A sedação foi feita com cetamina na dose de 1 a 2 mg/kg e diazepam 0,2 a 0,4 mg/kg de peso. RESULTADOS: Todas as cirurgias puderam ser realizadas com tranqüilidade com este método, com exceção de uma criança em que o bloqueio não foi efetivo e a anestesia complementada com inalação de halogenado, sob máscara. Como complicações pós-operatórias, ocorreram três hematomas, sendo um de parede e dois em bolsa escrotal, todos com boa evolução. CONCLUSÕES: O uso da anestesia local associada à sedação é procedimento simples e seguro para realizar herniorrafias inguinais em crianças.AIM: To describe an anesthetic technique, as well as the results of surgical treatment of the inguinal hernia in children. PATIENTS/METHODS: Forty-eight patients were submitted to inguinal hernia repair under local anesthesia at "Santa Casa de Misericórdia de Cerqueira César", State of São Paulo, Brazil. There were 34 male and 14 female patients, range from 3 months to 12 years old. Local anesthesia was performed with a dose of 5 mg/kg body weight of 1% lidocaine through iliohypogastric and ilioinguinal nerve blocks, medially to the anterior superior iliac spine, and at level of the pubic tubercle. Sedation was done with an association of ketamine (1 to 2 mg/kg and diazepam (0,2 to 0,4 mg/kg. RESULTS: In all patients except one the procedure was

  6. Analgesic efficacy of intracapsular and intra-articular local anaesthesia for knee arthroplasty

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    Andersen, L Ø; Husted, H; Kristensen, B B

    2010-01-01

    The optimal site for wound delivery of local anaesthetic after total knee arthroplasty is undetermined. Sixty patients having total knee arthroplasty received intra-operative infiltration analgesia with ropivacaine 0.2% and were then were randomly assigned to receive either intracapsular or intra......-articular catheters with 20 ml ropivacaine 0.5% given at 6 h and again at 24 h, postoperatively. Analgesic efficacy was assessed for 3 h after each injection, using a visual analogue score, where 0 = no pain and 100 = worst pain. There was no statistically significant difference between groups. Maximum pain relief...

  7. Anestesia local e sedação para cirurgia de implante coclear: uma alternativa possível Local anesthesia for cochlear implant surgery: a possible alternative

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    Rogério Hamerschmidt

    2010-10-01

    Full Text Available Aanestesia geral sempre foi motivo de dúvida dos pacientes que vão ser submetidos a qualquer cirurgia, especialmente o implante coclear. Como já realizamos as cirurgias otológicas com anestesia local e sedação, julgamos perfeitamente possível a realização da cirurgia do implante coclear também com esse tipo de anestesia, diminuindo os riscos, a morbidade e os custos para o hospital. OBJETIVOS: Estudo prospectivo para demonstrar a técnica anestésica e cirúrgica utilizada em três casos de adultos submetidos ao implante coclear, avaliando a segurança e a eficácia de tal técnica. MATERIAL E MÉTODOS: Foram feitas três cirurgias de implante coclear, duas com implante Cochlear e uma com Med-EL, sem intercorrências transoperatórias, durante a telemetria e no pós-operatório imediato. RESULTADOS: Os três pacientes adultos tiveram alta hospitalar aproximadamente três horas após a cirurgia, deambulando, sem eventos nauseosos, relatando um pós-operatório mais fácil do que esperavam, mesmo no momento da telemetria intraoperatória. CONCLUSÃO: Anestesia local e sedação é uma alternativa para casos selecionados de pacientes para o implante coclear, principalmente naqueles de mais idade ou que apresentem contraindicação para a anestesia geral, os riscos e a morbidade são menores.The aim of this paper is to illustrate the possibility of performing a cochlear implant surgery with local anesthesia and sedation, the anesthetic technique and the advantages of that in comparison to a general anesthesia. AIMS: prospective study demonstrating the possibility of doing cochlear implant surgery under local anesthesia and sedation. MATERIALS AND METHODS: we describe three successful cases operated under local anesthesia, including neural telemetry and the conditions the patient presented after the surgery, with a very good recovery and no complications during and after the procedure. RESULTS: these three surgeries show the possibility of

  8. Local anesthetics after total knee arthroplasty: intraarticular or extraarticular administration? A randomized, double-blind, placebo-controlled study

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    Andersen, L.O.; Kristensen, B.B.; Husted, H.

    2008-01-01

    evaluated. PATIENTS AND METHODS: 32 patients undergoing total knee replacement with high-volume (170 mL) 0.2% ropivacaine infiltration analgesia were randomized to receive injection of 20 mL ropivacaine (0.2%) intraarticularly plus 30 mL saline in the extraarticular wound space 24 hours postoperatively...... or to receive 20 mL ropivacaine (0.2%) intraarticularly plus 30 mL ropivacaine (0.2%) in the extraarticular wound space 24 hours postoperatively. Pain intensity at rest and with mobilization was recorded for 4 hours after administration of additional local anesthetics. RESULTS: Intensity of pain at rest, during...

  9. Sigmund Freud (1856-1939 e Karl Köller (1857-1944 e a descoberta da anestesia local Sigmund Freud (1856-1939 y Karl Köller (1857-1944 y el Descubrimiento de la anestesia local Sigmund Freud (1856-1939 and Karl Köller (1857-1944 and the Discovery of local anesthesia

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    Almiro dos Reis Jr

    2009-04-01

    Full Text Available JUSTIFICATVA E OBJETIVOS: O entendimento por vezes admitido de que Sigmund Freud teve a intuição de utilizar a cocaína como anestésico local para intervenções cirúrgicas, ou mesmo de que ele tenha tido algum papel na descoberta da anestesia local não é verídico. Os objetivos das pesquisas de Freud eram outros e o verdadeiro realizador da descoberta foi Karl Köller, sobre o que há argumentos irrefutáveis. Diante desses fatos, tem importância histórica o conhecimento correto da questão. CONTEÚDO: O texto refere-se às propriedades há muito conhecidas da cocaína. Recorda dados pessoais, atividades profissionais e científicas de Sigmund Freud e de Karl Köller. Apresenta as pesquisas de Freud sobre efeitos fisiopatológicos observados com a cocaína. Expõe as razões das duras críticas recebidas por Freud diante de conceitos por ele emitidos. Descreve a súbita, porém consciente e justificada idéia de Karl Köller de estudar cientificamente a cocaína como anestésico local em animais e seres humanos. Indica como foram realizadas as pesquisas pioneiras que culminaram com a descoberta da anestesia local por Köller e as duas exposições sobre esta, feitas em Viena. Relata a primeira intervenção cirúrgica oftalmológica sob anestesia local. Comprova a imediata difusão pelo mundo da descoberta que marcou o início da anestesia locorregional. Comenta numerosos documentos comprobatórios da prioridade de Köller na descoberta. Finalmente, menciona as numerosas homenagens recebidas por Köller em várias partes do mundo. CONCLUSÕES: A anestesia locorregional foi iniciada por Karl Köller em 1884, quando ele provou a possibilidade de praticar intervenções cirúrgicas oftalmológicas sem dor utilizando a cocaína como anestésico local. Sigmund Freud realizou muitas pesquisas sobre a cocaína, mas não participou diretamente do importantíssimo feito.JUSTIFICATIVA Y OBJETIVOS: Los que a veces se cree de que Sigmund Freud tuvo

  10. Anestesia Diploica em Endodontia

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    Macedo, Ricardo Ribeiro Veiga de

    2013-01-01

    Trabalho final do 5º ano com vista à atribuição do grau de mestre no âmbito do ciclo de estudos de Mestrado Integrado em Medicina Dentária apresentado à Faculdade de Medicina da Universidade de Coimbra. Objetivos Comparar a eficácia das técnicas de anestesia convencionais, a anestesia infiltrativa periapical, com a anestesia diploica. Metodologia Foram selecionados 32 voluntários, saudáveis, aos quais foram administradas ambas as técnicas anestésicas no dente 1.4. Numa primeira fase os...

  11. Increased localized delivery of piroxicam by cationic nanoparticles after intra-articular injection

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    Kim SR

    2016-11-01

    , polymeric nanoparticles, electrostatic interaction, intra-articular injection, local delivery, hyaluronic acid

  12. Hernias inguinales bilaterales operadas con anestesia local mediante hernioplastia de Lichtenstein Bilateral inguinal hernias operated on with local anesthesia by Lichtenstein hernioplasty

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    Bárbaro Agustín Armas Pérez

    2009-03-01

    Full Text Available INTRODUCCIÓN. La hernioplastia inguinal bilateral libre de tensión de Lichtenstein es una posibilidad real de tratamiento en pacientes con hernia inguinal bilateral. Este método es en esencia menos costoso para el paciente, la institución y la economía en general, y permite una reincorporación rápida a la sociedad, por lo cual en el presente estudio se presentaron los resultados de este protocolo de tratamiento, con la finalidad de evaluar su efectividad. MÉTODOS. Se realizó un estudio descriptivo transversal con los primeros 38 pacientes operados con la técnica de Lichtenstein mediante anestesia local (técnica combinada de Braun y de Shleider. Los pacientes fueron operados de forma ambulatoria entre enero de 2001 y diciembre del 2007. Se dio el alta en la tarde, si la operación fue en la mañana; y al amanecer del día siguiente, si se operó en la tarde, con el objetivo de evitar la equimosis declive con la movilización precoz. RESULTADOS. Cuatro de los pacientes presentaban hernias recurrentes. El material protésico más empleado fue el polipropileno (86,9 %. Las complicaciones alcanzaron el 9,1 % (referidas no a los 38 pacientes, sino a las 76 hernioplastias; y después de un seguimiento que osciló entre 1 y 36 meses, se presentó un rechazo al material protésico (1,3 % y una recidiva (1,3 %. CONCLUSIONES. Se concluyó que este procedimiento es aplicable a las hernias bilaterales, ya que el estrés, los costos institucionales y las molestias del paciente se reducen, con lo cual demuestra su eficacia.INTRODUCTION. Lichtenstein's tension free bilateral inguinal hernioplasty is a real possibility for treating patients with bilateral inguinal hernia. This method is essentially less expensive for the patient, the institution and the economy in general, and it allows a fast reincorporation to society. Therefore, the results of this treatment protocol were included in the present study aimed at evaluating its effectiveness. METHODS

  13. Dexmedetomidina associada a propofol em sedação durante anestesia local para cirurgia plástica Dexmedetomidina asociada a propofol en sedación durante anestesia local para cirugía plástica Dexmedetomidine/propofol association for plastic surgery sedation during local anesthesia

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    José Roberto Nociti

    2003-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A dexmedetomidina é um novo agonista alfa2-adrenérgico com propriedades potencialmente úteis em anestesia. Este estudo comparativo tem por finalidade observar os efeitos da dexmedetomidina sobre o consumo de propofol e a evolução dos parâmetros cardiovasculares e respiratórios, quando incluída em técnica de sedação durante anestesia local em cirurgia plástica. MÉTODO: Participaram do estudo 40 pacientes do sexo feminino com idades entre 16 e 60 anos, estado físico ASA I ou II, submetidas a cirurgias plásticas eletivas sob anestesia local. Foram distribuídas aleatoriamente em dois grupos de vinte: C (controle e D (dexmedetomidina. Em ambos, a sedação foi obtida com propofol na dose em bolus inicial de 1 mg.kg-1 seguida de infusão contínua em velocidade ajustada para se obter grau de sedação consciente. No grupo D, as pacientes receberam infusão venosa contínua de dexmedetomidina à velocidade de 0,01 µg.kg-1.min-1, concomitante com a de propofol. Foram avaliados: efeito da dexmedetomidina sobre o consumo de propofol; variação dos parâmetros cardiovasculares (PAS, PAD, PAM, FC e respiratórios (SpO2, P ET CO2; qualidade do controle do sangramento per-operatório e características da recuperação pós-anestésica. RESULTADOS: A velocidade média de infusão de propofol foi menor no grupo D (35,2 ± 5,3 µg.kg-1.min-1 do que no grupo C (72,6 ± 8,5 µg.kg-1.min-1. Os valores médios de PAS, PAD e PAM decresceram em relação ao inicial, a partir dos 30 minutos, no grupo D, mantendo-se a seguir estáveis até o final; no grupo C, aumentaram. A FC manteve-se estável no grupo D e aumentou a partir dos 30 minutos no grupo C. O tempo médio para obedecer ao comando de "abrir os olhos" foi menor no grupo D (6,3 ± 2,5 min em relação ao C (8,9 ± 2,7 min. O controle do sangramento per-operatório foi superior no grupo D em relação ao C. CONCLUSÕES: O emprego da dexmedetomidina associada ao

  14. Increased localized delivery of piroxicam by cationic nanoparticles after intra-articular injection.

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    Kim, Sung Rae; Ho, Myoung Jin; Kim, Sang Hyun; Cho, Ha Ra; Kim, Han Sol; Choi, Yong Seok; Choi, Young Wook; Kang, Myung Joo

    2016-01-01

    Piroxicam (PRX), a potent nonsteroidal anti-inflammatory drug, is prescribed to relieve postoperative and/or chronic joint pain. However, its oral administration often results in serious gastrointestinal adverse effects including duodenal ulceration. Thus, a novel cationic nanoparticle (NP) was explored to minimize the systemic exposure and increase the retention time of PRX in the joint after intra-articular (IA) injection, by forming micrometer-sized electrostatic clusters with endogenous hyaluronic acid (HA) in the synovial cavity. PRX-loaded NPs consisting of poly(lactic- co -glycolic acid), Eudragit RL, and polyvinyl alcohol were constructed with the following characteristics: particle size of 220 nm, zeta potential of 11.5 mV in phosphate-buffered saline, and loading amount of 4.0% (w/w) of PRX. In optical and hyperspectral observations, the cationic NPs formed more than 50 μm-sized aggregates with HA, which was larger than the intercellular gaps between synoviocytes. In an in vivo pharmacokinetic study in rats, area under the plasma concentration-time curve (AUC 0-24 h ) and maximum plasma concentration ( C max ) of PRX after IA injection of the cationic NPs were <70% ( P <0.05) and 60% ( P <0.05), respectively, compared to those obtained from drug solution. Moreover, the drug concentration in joint tissue 24 h after dosing with the cationic NPs was 3.2-fold ( P <0.05) and 1.8-fold ( P <0.05) higher than that from drug solution and neutrally charged NPs, respectively. Therefore, we recommend the IA cationic NP therapy as an effective alternative to traditional oral therapy with PRX, as it increases drug retention selectively in the joint.

  15. Anestesia e artrite reumatoide

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    Eneida Maria Vieira

    2011-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A artrite reumatoide (AR é uma doença inflamatória crônica e de etiologia desconhecida. Os pacientes com AR são reconhecidos como pessoas com redução na expectativa de vida, em comparação com a população em geral. As doenças reumáticas são numerosas e ocorrem com alta variabilidade; algumas são desenvolvidas rapidamente; outras, cronicamente, provocando incapacidades durante toda a vida. Os riscos anestésicos, em desordens osteoarticulares, envolvem, além das deformidades mecânicas causadas pela doença, os sistemas cardiovascular, respiratório, renal e digestivo. CONTEÚDO: A proposta da presente revisão foi levantar a importância das fases da doença em processo, que podem influenciar no controle da anestesia antes, durante e após a cirurgia, destacando a experiência dos autores em uma avaliação retrospectiva dos casos de pacientes portadores de artrite reumatoide juvenil (ARJ submetidos a próteses ortopédicas, com ênfase para as técnicas de intubação. CONCLUSÕES: Pacientes com artrite reumatoide podem apresentar um bom número de problemas complexos para o anestesiologista. Isso requer uma cuidadosa avaliação pré-operatória; a anestesia requer experiência com a técnica e o cuidado pós-operatório deve ser criteriosamente escolhido para atender à necessidade específica do paciente. O procedimento demanda efetiva comunicação entre cirurgião, reumatologista e anestesiologista, para que cada membro do grupo multidisciplinar contribua com sua experiência, visando a um melhor benefício ao paciente.

  16. NEUROCIENCIA Y ANESTESIA

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    Antonello Penna S., Dr., MD, PhD

    2017-09-01

    Full Text Available RESUMEN: Uno de los focos principales de la neurociencia es entender las funciones cerebrales superiores y cómo estas son inhibidas de manera reversible por los anestésicos generales. Por ello, la comprensión del mecanismo de acción de estos fármacos, que rutinariamente se utilizan en la práctica clínica, ha permitido avanzar enormemente en entender cómo se integra la información a nivel cerebral para establecer las nuevas memorias, la capacidad de reaccionar al medio externo y las bases de la consciencia. Desde la primera demostración pública exitosa del efecto de los anestésicos generales hasta nuestros días se ha determinado que los anestésicos actúan en bolsillos hidrofóbicos de receptores proteicos localizados en la membrana plasmática de las neuronas corticales y subcorticales, generando una disminución de la excitabilidad de las redes neuronales. Este efecto puede ser evidenciado por registros electroencefalográficos que han permitido registrar en línea el efecto de cada uno de los anestésicos. De este modo, se ha podido establecer que la anestesia es diferente al sueño, más bien corresponde a un coma farmacológico reversible. Sin embargo, pese a todos los avances, aún quedan muchas preguntas por responder, lo cual es el objetivo de las futuras investigaciones. SUMMARY: One of the main focus of neuroscience is to understand the higher brain functions, which are reversibly inhibited by general anesthetics. Therefore, understanding the mechanism of action of these drugs, which are routinely used in clinical practice, has allowed a great advance in how information is integrated in the brain to establish new memories, the ability to react to external environment and the consciousness. Since the first successful public demonstration of the effect of general anesthetics to the present day, it has been determined that anesthetics act on hydrophobic pockets of protein receptors in cortical and subcortical neurons

  17. Citocinas e anestesia

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    João Batista Santos Garcia

    2002-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Vários trabalhos têm abordado as citocinas que podem ser estimuladas e liberadas por lesão cirúrgica, trauma, infecção, inflamação e câncer. Níveis elevados circulantes das citocinas parece ter implicações no aparecimento de complicações e retardo da recuperação pós-operatória de pacientes. O objetivo da presente revisão é resumir as informações hoje disponíveis sobre citocinas. CONTEÚDO: As citocinas são moléculas polipeptídicas produzidas por uma grande variedade de células e parecem não ter função na homeostase, sob condições normais. Esses mediadores são responsáveis por respostas locais ou sistêmicas, gerando alterações imunológicas, metabólicas, hemodinâmicas, endócrinas e neurais. Podem ativar respostas biológicas benéficas, como estimulação da função antimicrobiana, cicatrização de feridas, mieloestimulação e mobilização de substratos. No entanto, a secreção abundante de citocinas está associada a efeitos deletérios como hipotensão arterial, falência de órgãos e morte. CONCLUSÕES: Ao concluir esta revisão, fica evidente que as citocinas desempenham um papel de fundamental importância como mediadores de respostas metabólicas, hormonais, imunológicas e hematológicas, que há potencial terapêutico com o bloqueio de sua expressão e que a anestesia pode interferir de alguma forma na sua ativação. No entanto, muitas perguntas não estão ainda respondidas e estudos devem ser realizados nos próximos anos buscando esclarecer as ações das citocinas não só para a experimentação mas também para a prática clínica.

  18. Comparison of interscalene brachial plexus block and intra-articular local anesthetic administration on postoperative pain management in arthroscopic shoulder surgery

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    Recep Aksu

    2015-06-01

    Full Text Available BACKGROUND AND OBJECTIVES: In this study, the aim was to compare postoperative analgesia effects of the administration of ultrasound-guided interscalene brachial plexus block and intra-articular bupivacaine carried out with bupivacaine. METHODS: In the first group of patients 20 mL 0.25% bupivacaine and ultrasound-guided interscalene brachial plexus block (ISPB were applied, while 20 mL 0.25% bupivacaine was given via intra-articular (IA administration to the second group patients after surgery. Patients in the third group were considered the control group and no block was performed. Patient-controlled analgesia (PCA with morphine was used in all three groups for postoperative analgesia. RESULTS: In the ISPB group, morphine consumption in the periods between 0-4, 6-12 and 12-24 postoperative hours and total consumption within 24 h was lower than in the other two groups. Morphine consumption in the IA group was lower than in the control group in the period from 0 to 6 h and the same was true for total morphine consumption in 24 h. Postoperative VASr scores in the ISPB group were lower than both of the other groups in the first 2 h and lower than the control group in the 4th and 6th hours (p < 0.05. In the IA group, VASr and VASm scores in the 2nd, 4th and 6th hours were lower than in the control group (p < 0.05. CONCLUSION: Interscalene brachial plexus block was found to be more effective than intra-articular local anesthetic injection for postoperative analgesia.

  19. Local intra-articular injection of resveratrol delays cartilage degeneration in C57BL/6 mice by inducing autophagy via AMPK/mTOR pathway.

    Science.gov (United States)

    Qin, Na; Wei, Liwei; Li, Wuyin; Yang, Wei; Cai, Litao; Qian, Zhuang; Wu, Shufang

    2017-07-01

    Autophagy is an essential cellular homeostasis mechanism that was found to be compromised in aging and osteoarthritis (OA) cartilage. Previous studies showed that resveratrol can effectively regulate autophagy in other cells. The purpose of this study was to determine whether the chondroprotective effect of resveratrol was related to chondrocyte autophagy and to elucidate underlying mechanisms. OA model was induced by destabilization of the medial meniscus (DMM) in 10-week-old male mice. OA mice were treated with resveratrol with/without 3-MA for 8 weeks beginning 4 weeks after surgery. The local intra-articular injection of resveratrol delayed articular cartilage degradation in DMM-induced OA by OARSI scoring systems and Safranin O-fast green. Resveratrol treatment increased Unc-51-like kinase1, Beclin1, microtubule-associated protein light chain 3, hypoxia inducible factor-1α, phosphorylated AMPK, collagen-2A1, Aggrecan expressions, but decreased hypoxia inducible factor-2α, phosphorylated mTOR, matrix metalloproteinases13 and a disintegrin and metalloproteinase with thrombospondin motifs 5 expressions. The effects of resveratrol were obviously blunted by 3-MA except HIF and AMPK. These findings indicate that resveratrol intra-articular injection delayed articular cartilage degeneration and promoted chondrocyte autophagy in an experimental model of surgical DMM-induced OA, in part via balancing HIF-1α and HIF-2α expressions and thereby regulating AMPK/mTOR signaling pathway. Copyright © 2017 The Authors. Production and hosting by Elsevier B.V. All rights reserved.

  20. Randomized clinical trial comparing spinal anesthesia with local anesthesia with sedation for loop colostomy closure Ensaio clínico randomizado comparando raquianestesia com anestesia local, associadas à sedação para o fechamento de colostomia em alça

    Directory of Open Access Journals (Sweden)

    Rone Antônio Alves de Abreu

    2010-09-01

    Full Text Available CONTEXT: Recent studies have shown that local anesthesia for loop colostomy closure is as safe as spinal anesthesia for this procedure. OBJECTIVES: Randomized clinical trial to compare the results from these two techniques. METHODS: Fifty patients were randomized for loop colostomy closure using spinal anesthesia (n = 25 and using local anesthesia (n = 25. Preoperatively, the bowel was evaluated by means of colonoscopy, and bowel preparation was performed with 10% oral mannitol solution and physiological saline solution for lavage through the distal colostomy orifice. All patients were given prophylactic antibiotics (cefoxitin. Pain, analgesia, reestablishment of peristaltism or peristalsis, diet reintroduction, length of hospitalization and rehospitalization were analyzed postoperatively. RESULTS: Surgery duration and local complications were greater in the spinal anesthesia group. Conversion to general anesthesia occurred only with spinal anesthesia. There was no difference in intraoperative pain between the groups, but postoperative pain, reestablishment of peristaltism or peristalsis, diet reintroduction and length of hospitalization were lower with local anesthesia. CONCLUSIONS: Local anesthesia plus sedation offers a safer and more effective method than spinal anesthesia for loop colostomy closure.CONTEXTO: Estudos recentes têm demonstrado que a anestesia local para o fechamento de colostomia em alça é tão segura quanto a raquianestesia para estes procedimentos. OBJETIVOS: Comparar os resultados do fechamento de colostomia em alça usando essas duas técnicas. MÉTODOS: Cinquenta pacientes foram randomizados para o fechamento de colostomia em alça sob raquianestesia (n = 25 e anestesia local (n = 25. No pré-operatório, o cólon foi avaliado por colonoscopia e o preparo intestinal foi realizado com solução oral de manitol a 10% e limpeza com solução salina fisiológica através do orifício distal da colostomia. Todos os

  1. Videolaringoscopios en Anestesia Obstétrica

    OpenAIRE

    Acosta Martínez, Jesús

    2016-01-01

    En cualquier escenario, la Vía Aérea Difícil (VAD) es la mayor causa de morbilidad y mortalidad relacionada con la intubación. En el contexto de la anestesia general de la paciente obstétrica, el manejo de la vía aérea toma especial relevancia dada la alta prevalencia de intubaciones dificultosas y/o fallidas, a pesar de los múltiples avances recientes en la materia. Las complicaciones de la anestesia general persisten como causa de mortalidad asociada a la anestesia en las mujeres embaraz...

  2. A pharmacokinetic/clinical approach to postulate a local action of intra-articular xylazine administration in the horse: a preliminary study.

    Science.gov (United States)

    Di Salvo, A; Della Rocca, G; Bazzica, C; Giontella, A; Cagnardi, P; Nannarone, S

    2014-10-01

    The study aims to evaluate whether the analgesic effect of intra-articular (IA) route of xylazine administered to horses following arthroscopic surgery is due to a local or a systemic action. Two connected studies were performed. In the first, 1 mg/kg b.w. of xylazine was injected IA, and blood samples were taken to assess drug systemic absorption. In addition, systemic effects of the drug (sedation, ataxia or reduction of respiratory and cardiac rate) were registered. Control horses injected with saline IA were included in the study to exclude the influence of anaesthesia in the occurrence of these manifestations. In the second study, 1 mg/kg b.w. of xylazine was administered intravenously (i.v.) in healthy horses. Blood samples were collected to determine the concentrations of xylazine, and the same signs of systemic effects of the drug were recorded. By correlating these parameters, a systemic 'no effect' concentration was defined. Pharmacokinetic data after IA administration resulted in some xylazine absorption (bioavailability equal to 58.12%) with values above the systemic 'no effect' concentration. The occurrence of some signs related to systemic effects in horses receiving IA xylazine was significant compared with horses receiving saline. In conclusion, a systemic action of the drug after IA administration cannot be excluded. © 2014 John Wiley & Sons Ltd.

  3. Análise de custos entre a raquianestesia e a anestesia venosa com propofol associada ao bloqueio perianal local em operações anorretais Cost analysis between spinal and venous anesthesia with propofol associated with local perianal block in anorectal procedures

    Directory of Open Access Journals (Sweden)

    Paulo Gustavo Kotze

    2009-09-01

    Full Text Available RACIONAL: Atualmente cerca de 90% das operações anorretais podem ser realizadas em regime ambulatorial. A técnica anestésica é fator fundamental na busca de menor tempo de internamento e redução de custos nestes procedimentos. Não há consenso na literatura sobre qual o melhor tipo de anestesia para essas operações. OBJETIVO: Comparar os custos da técnica de raquianestesia com bupivacaína 0,5% isobárica com a técnica de anestesia venosa com propofol associada ao bloqueio perianal local com lidocaína a 2% e bupivacaína 0,5% (anestesia combinada em pacientes submetidos a operações anorretais. MÉTODOS: Foram analisados dados de 99 pacientes submetidos à operações anorretais, divididos em dois grupos: grupo I (raquianestesia, composto por 50 pacientes e grupo II (anestesia combinada, composto por 49 pacientes. Foram estudados os procedimentos cirúrgicos, tempo de procedimento anestésico-cirúrgico, tempo de internamento e custos globais de cada paciente. RESULTADOS: Não houve diferença estatística significativa entre os grupos estudados em relação ao tipo de procedimento cirúrgico, sexo, idade e complicações. O tempo médio do procedimento anestésico-cirúrgico, no grupo I foi de 53,1 minutos e de 44,08 minutos no grupo II (P=0,034. O tempo médio de internamento foi de 19,68 horas no grupo I e de 7,08 horas no grupo II (PBACKGROUND: Approximately ninety percent of anorectal surgical procedures are performed in ambulatory basis. The choice of a proper anesthetic technique is important to achieve shorter hospital stay and low costs. There's no evidence in the literature that an ideal type of anesthesia for these procedures exists. AIM: To compare the costs of patients operated with spinal anesthesia (0,5% bupivacaine with combined anesthesia (propofol and local perineal block with 2% lidocaine and 0,5% bupivacaine in anorectal surgical procedures. METHODS: Data from 99 patients submitted to anorectal operations were

  4. Estudo comparativo entre anestesia peridural torácica e anestesia geral em mastectomia oncológica Estudio comparativo entre la anestesia epidural torácica y la anestesia general en mastectomia oncológica Comparative study between thoracic epidural block and general anesthesia for oncologic mastectomy

    Directory of Open Access Journals (Sweden)

    Sérgio D. Belzarena

    2008-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A anestesia peridural torácica é utilizada com freqüência para procedimentos estéticos da mama e há poucos relatos de seu emprego para mastectomias com exploração axilar. O presente estudo comparou a técnica com anestesia geral em operações oncológicas da mama. MÉTODO: Quarenta pacientes foram divididas em dois grupos. No grupo peridural (n = 20 foi realizada peridural torácica com bupivacaína e fentanil associada à sedação com midazolam. O outro grupo (n = 20 recebeu anestesia geral convencional com propofol, atracúrio e fentanil e manutenção com O2 e isoflurano. Registraram-se no intra-operatório duração da operação, necessidade de complementação da anestesia ou da sedação e variáveis hemodinâmicas. No pós-operatório, foram registrados o tempo para alta da sala de recuperação pós-anestésica e hospitalar, a intensidade da dor e o consumo de analgésicos, os efeitos adversos e a satisfação com a técnica anestésica. RESULTADOS: Os grupos foram semelhantes e não houve diferença na duração da operação. Foi necessário complementar a sedação em 100% das pacientes que receberam anestesia peridural e em 15% foi complementada a analgesia com infiltração de anestésico local na axila. Houve maior incidência de hipertensão arterial no grupo da anestesia geral e de hipotensão entre as que receberam peridural. Ocorreu prurido em 55% das pacientes com anestesia peridural. Náusea (30% e vômito (45% foram mais freqüentes entre as que receberam anestesia geral. A analgesia pós-operatória teve melhor qualidade e o consumo de analgésicos foi menor no grupo da anestesia peridural. O período de internação também foi menor. CONCLUSÕES: A técnica peridural tem algumas vantagens com relação à anestesia geral e pode ser considerada uma opção para anestesia em mastectomias oncológicas com esvaziamento axilar.JUSTIFICATIVA Y OBJETIVOS: La anestesia epidural torácica se

  5. Effectiveness of intra-articular lidocaine injection for reduction of anterior shoulder dislocation: randomized clinical trial Efetividade da injeção intrarticular de lidocaína na redução das luxações anteriores do ombro: ensaio clínico randomizado

    Directory of Open Access Journals (Sweden)

    Marcel Jun Sugawara Tamaoki

    2012-01-01

    Full Text Available CONTEXT AND OBJECTIVE: Shoulder dislocation is the most common dislocation among the large joints. The aim here was to compare the effectiveness of reduction of acute anterior shoulder dislocation with or without articular anesthesia. DESIGN AND SETTING: Prospective randomized trial conducted in Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp. METHODS: From March 2008 to December 2009, 42 patients with shoulder dislocation were recruited. Reductions using traction-countertraction for acute anterior shoulder dislocation with and without lidocaine articular anesthesia were compared. As the primary outcome, pain was assessed through application of a visual analogue scale before reduction, and one and five minutes after the reduction maneuver was performed. Complications were also assessed. RESULTS: Forty-two patients were included: 20 in the group without analgesia (control group and 22 in the group that received intra-articular lidocaine injection. The group that received intra-articular lidocaine had a statistically greater decrease in pain over time than shown by the control group, both in the first minute (respectively: mean 2.1 (0 to 5.0, standard deviation, SD 1.3, versus mean 4.9 (2.0 to 7.0, SD 1.5; P CONTEXTO E OBJETIVO: A luxação do ombro é a mais frequente luxação das grandes articulações. O objetivo foi comparar a efetividade da redução da luxação anterior aguda do ombro, com ou sem anestesia articular. TIPO DE ESTUDO E LOCAL: Ensaio clínico randomizado desenvolvido na Escola Paulista de Medicina - Universidade Federal de São Paulo (EPM-Unifesp. MÉTODOS: De março de 2008 a dezembro de 2009 foram recrutados 42 pacientes com luxação anterior do ombro agudas. Foi comparada a redução de tração e contra-tração com e sem anestesia intra-articular com lidocaína. Como desfecho primário, a dor foi avaliada por meio da escala visual analógica antes da redução e um e cinco minutos após a

  6. Intra-articular morphine in horses

    DEFF Research Database (Denmark)

    Lindegaard, Casper

    separated by a three week washout period. Before each treatment, radiocarpal synovitis was induced by IA injection of lipopolysaccharide (LPS). For each of the two 168-hours study periods, local and systemic measures of pain and inflammation as well as blood and synovial fluid (SF) samples...... for pharmacological analysis were obtained repeatedly. Pain was evaluated by degree of lameness as well as using a visual analogue scale of pain intensity (VAS) and a composite measure pain scale (CMPS), developed for this purpose. Intra-articular injection of LPS elicited a marked synovitis resulting in lameness...... and pain. Intra-articularly administered morphine showed a significant analgesic effect as measured by reduced lameness scores, less administered rescue analgesia and lower pain scores. A significant anti-inflammatory effect was demonstrated by reduced joint swelling, reduced SF serum amyloid A (SAA...

  7. Anestesia extra-dural en el parto

    Directory of Open Access Journals (Sweden)

    Alberto Cárdenas Escobar

    1956-05-01

    Full Text Available Desde que A. J. Corning practicó en 1885 la primera inyección de una solución de cocaína en el espacio epidural, diversos métodos anestésicos que utilizan este espacio han sido ensayados, tanto en cirugía como en obstetricia. Sicard y Cathelin, en 1901, usaron el hiatus sacro para anestesia epidural en operaciones urológicas. Stoeckel y Schlimpert en 1911 fueron los primeros en emplear este método en obstetricia. Reemplazaron la cocaína por novocaína. recientemente preparada, y lograron analgesia bastante satisfactoria durante 30 minutos a 1 hora, en casos seleccionados

  8. Avaliação da analgesia pós-operatória em pacientes submetidos à cirurgia orificial com anestesia local associada ou não à morfina Evaluation of the postoperative analgesia in patients submitted to anorectal surgery with local anesthesia associated or not the morphine

    Directory of Open Access Journals (Sweden)

    Juvenal da Rocha Torres Neto

    2007-03-01

    Full Text Available Ainda não esta comprovada a eficácia dos derivados morfínicos ao nível de receptores opióides periféricos. Estudos procuram demonstrar o poder da droga em interferir na intensidade da dor quando infiltrada em nervos periféricos. Avaliamos, então, a infiltração local de morfina associada à anestesia local em cirurgias orificiais proctológicas. Nesse estudo foram analisados 61 pacientes, independentemente do gênero, sendo divididos aleatoriamente em dois grupos: a um grupo foi associada morfina ao anestésico local enquanto ao outro houve a administração do anestésico local sem a droga morfínica. Os pacientes de ambos os grupos foram submetidos à sedação e analgesia pós-operatória padronizadas. Foram avaliados: a intensidade da dor, a analgesia pós-operatória e a morbidade. A intensidade da dor, no momento de seu surgimento, foi semelhante nos dois grupos; o tempo de analgesia pós-operatória foi maior no grupo em que a morfina foi administrada, entretanto, não se mostrou estatisticamente significativo; as complicações pós-operatórias foram irrelevantes nos dois grupos. Dessa forma, a infiltração local de morfina na região anorretal tem benefícios em relação à analgesia pós-operatória que não mostraram significância estatística e não aumenta a incidência dos efeitos colaterais tão temidos relacionados às drogas morfínicas como retenção urinária e prurido.It has not been proved the efficacy of morphine derived at periphery opium receivers. Studies are trying to demonstrate the power of the drug to interfere in the intensity of surgical pain while infiltrating in the periphery nerves. This study evaluated the infiltration of morphine associated with local anesthesia in anorectal surgery. Sixty one patients were analyzed, male and female, divided in two groups: in one group was associated morphine in the local anesthesia while in the other group only the local anesthetic was used. The patients of both

  9. Falhas na anestesia subaracnóidea Fallos en la anestesia subaracnoide Failure of subarachnoid blocks

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    Hugo Praxedes

    2010-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Desde Bier, é descrita falha de anestesia subaracnóidea que causa desconforto ao paciente e que ocorre, eventualmente, mesmo diante de profissionais hábeis que a tenham conduzido de forma tecnicamente correta. Há variação, no entanto, de conceito de falha e, principalmente, de identificação precisa de causas. O objetivo do trabalho é identificar melhor as causas deste desconforto por meio de revisão sistemática de publicações com casuística significativa. CONTEÚDO: Dividiu-se a análise em três tópicos: anatomia e suas variações; o agente anestésico, que trata da seleção do agente, suas soluções e adições, de forma a atingir o resultado mais apropriado à intervenção cirúrgica proposta; e a dose, discutindo-se concentração, volume ou dose gravimétrica, no sentido de obter resultado mais adequado tanto no que diz respeito à intensidade do bloqueio quanto à sua duração. CONCLUSÕES: As falhas são mais afeitas a fatores técnicos: avaliação anatômica adequada, escolha criteriosa da agulha e do local da punção, cuidados no armazenamento dos agentes, adequação de dose, baricidade, além de posicionamento correto do paciente durante e após punção, tudo adequado ao objetivo cirúrgico.JUSTIFICATIVA Y OBJETIVOS: Bier ya describía los fallos en la anestesia subaracnoidea que causa la incomodidad al paciente, y que se da, eventualmente, incluso con la presencia de profesionales hábiles que la hayan conducido de forma técnicamente correcta. Existe una variación, sin embargo, del concepto de fallo y principalmente, de la identificación precisa de las causas. El objetivo del trabajo es identificar mejor las causas de esa incomodidad a través de la revisión sistemática de publicaciones con casuística significativa. CONTENIDO: El análisis se dividió en tres tópicos: la anatomía y sus variaciones; el agente anestésico, que trata sobre la selección del agente, sus soluciones

  10. Historia de la Anestesia en Colombia

    Directory of Open Access Journals (Sweden)

    Efraím Otero-Ruiz

    2000-08-01

    Full Text Available

    Con el patrocinio de la Sociedad Colombiana de Anestesiología y Reanimación (SCARE y pulcramente editado por Gente Nueva Editorial, en Julio de 1999 ha publicado el Académico Jaime Herrera Pontón su volumen “Historia de la Anestesia en Colombia“, aparecido justamente con motivo de los 50 años de fundación de dicha Sociedad.

    El volumen, de pasta dura y de 300 páginas, con prólogo de Luis Duque Gómez, Presidente de la Academia Colombiana de Historia e ilustrado con numerosas fotografías, está dividido en 14 capítulos y 3 apéndices, precedidos de una introducción a cargo del autor.

    Los 4 primeros capítulos, desde la conquista y la colonia hasta los primeros decenios de nuestra república, describen las primeras plantas sedantes y analgésicas nativas lo mismo que los primeros venenos paralizantes empleados por nuestros aborígenes, el opio empleado como profundo analgésico en nuestras guerras emancipadoras y la creación de los primeros programas de estudios médicos en Colombia. De ahí arrancan dos extensos capítulos, pivotales en el desarrollo de esta historia: el 50., titulado “El siglo XIX desde la primera demostración del éter” y el 60. “El siglo XX hasta la creación de la Sociedad Colombiana de Anestesia”. En ellos se describen de manera más o menos suscinta los primeros esfuerzos para diferenciar las técnicas anestésicas de las quirúrgicas propiamente dichas y el lento pero prodigioso esfuerzo por hacer de la anestesiología una especialidad médica, fenómeno que no sucede hasta bien entradas la 4a. y 5a. décadas del pasado siglo. Esos primeros cien años, como sucede en el resto del mundo occidental, estarán dominados por el éter y el cloroformo en método abierto ya que otros agentes, como el etileno y el ciclopropano, apenas comienzan a llegar en vísperas de la lIa. Guerra Mundial, lo mismo que los primeros aparatos de circuito cerrado, la inducción por barbitúricos intravenosos y

  11. Anestesia para cesárea en paciente con acondroplasia

    OpenAIRE

    Osorio Rudas, Walter; Socha García, Nury Isabel; Upegui, Alejandro; Ríos Medina, Ángela; Moran, Adrian; Aguirre Ospina, Oscar; Rivera, Carlos

    2012-01-01

    Introducción: En gestantes acondroplásicas se recomienda el parto por cesárea con anestesia general; sin embargo, recientemente se ha reportado el uso de técnicas conductivas con resultados adecuados. Objetivo:Describir el manejo anestésico de una paciente con acondroplasia programada para cesárea utilizando anestesia combinada espinal-epidural. Métodos y resultados:Mostramos el caso de una primigestante acondroplásica con 110 cm de estatura y embarazo de 37 semanas, en quien se realizó cesár...

  12. Incidência de tremor em anestesia peridural com ou sem fentanil: estudo comparativo

    Directory of Open Access Journals (Sweden)

    Abreu Múcio Paranhos de

    2004-01-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A maioria dos trabalhos encontrados na literatura, relacionando a influência dos opióides administrados por via peridural com o tremor intra e pós-operatório, foram realizados com grupos de pacientes obstétricas, nas quais a resposta do centro termorregulador pode ser diferente das pacientes não grávidas. O objetivo deste trabalho foi comparar o bloqueio peridural com e sem fentanil, quanto à incidência de tremores e outras complicações no intra e pós-operatório em pacientes submetidos à cirurgia de varizes sob anestesia peridural com bupivacaína a 0,5% com adrenalina a 1:200.000. MÉTODO: Trinta e quatro pacientes, estado físico ASA I e II, submetidos à cirurgia para tratamento de varizes de membros inferiores, foram divididos aleatoriamente em 2 grupos (n = 17, e receberam midazolam (0,05 mg.kg-1, por via venosa seguido de anestesia peridural lombar, utilizando-se no grupo S, 20 ml bupivacaína a 0,5% (com vasoconstritor associado a 2 ml de solução fisiológica a 0,9% e no grupo F, 20 ml de bupivacaína a 0,5% (com vasoconstritor associada ao fentanil (100 µg. Foram estudados: incidência de tremor, temperatura dos pacientes, necessidade do uso de meperidina, e a incidência de náuseas e vômitos nos seguintes momentos: M1 - admissão do paciente na sala de operação; M2 - imediatamente antes da anestesia; M3 - 30 minutos após o término da injeção do anestésico local; M4 - 60 minutos após o término da injeção do anestésico local; M5 - 90 minutos após o término da injeção do anestésico local; M6 - final da anestesia; M7 - antecedendo a alta da sala de recuperação pós-anestésica. RESULTADOS: Quanto aos dados antropométricos, estado físico, tempo médio de duração da anestesia e cirurgia, temperatura dos pacientes e da sala de operação e incidência de náuseas e vômitos não houve diferença estatística entre os grupos. Houve diferença estatística aos 60 minutos (M4 e

  13. ¿QUÉ HACEMOS LOS ANESTESIÓLOGOS? DESDE LA VIGILANCIA ANESTÉSICA MONITORIZADA HASTA LA ANESTESIA GENERAL

    Directory of Open Access Journals (Sweden)

    Ricardo Bustamante, Dr.

    2017-09-01

    Full Text Available RESUMEN: La anestesiología es la rama de la medicina dedicada al alivio del dolor y al total cuidado del paciente antes, durante y después de un acto quirúrgico. Es una de las especialidades de la medicina que más ha avanzado en los últimos 40 años. Es así que hoy se operan pacientes que nunca se hubiera pensado que podrán operarse, llegando a cifras de mortalidad por causa anestésica bajísimas.Los anestesiólogos administran diferentes tipos de anestesia: desde la vigilancia del paciente despierto o con diversos grados de sedación, sin anestesia o con anestesia local, hasta la realización de variados tipos de bloqueos periféricos, bloqueos neuroaxiales o diferentes tipos de anestesia general (inhalatoria, endovenosa total o una mezcla de ambas.La actividad del anestesiólogo se ha extendido a muchas actividades fuera del pabellón quirúrgico, especialmente a procedimientos radiológicos, hemodinámicos, oncológicos, endoscópicos y dentales.Con el tiempo, se han desarrollado algunas subespecialidades en la anestesiología: cuidados intensivos, dolor crónico, anestesia pediátrica, anestesia cardiovascular, anestesia obstétrica, cuidados paliativos anestesia regional. Algunas actividades de la medicina los anestesiólogos las comparten con otros especialistas. Las más comunes son la medicina intensiva, el manejo del dolor crónico y los cuidados paliativos.Otra especialidad multidisciplina, que está surgiendo e instalándose en la medicina moderna es la medicina perioperatoria. La mayoría de los anestesiólogos practican en cierto grado la medicina perioperatoria y constituye probablemente el futuro de la anestesia, si es que nuestra especialidad desea prosperar. SUMMARY: Anesthesiology is the branch of medicine dedicated to relieve pain and total patient care before, during and after a surgical procedure. It is one of the medical specialties that has advanced

  14. Meningitis tras anestesia espinal Meningitis after a spinal anesthesia

    OpenAIRE

    A. L. Vázquez-Martínez; F. Castro; G. Illodo; E. Freiré; M. A. Camba

    2008-01-01

    La meningitis post-punción es una importante complicación de la anestesia espinal. Describimos el caso de un varón de cuarenta y seis años que ingresó para tratamiento quirúrgico de una hernia umbilical, la cirugía se realizó bajo anestesia intradural. Tras la intervención el paciente comenzó con un cuadro clínico compatible con meningitis, que se confirmó tras examen del líquido cefalorraquídeo. Se trató con antibióticos a pesar de la no identificación de gérmenes, siendo la evolución favora...

  15. On the main stages of the history of intra-articular therapy

    Directory of Open Access Journals (Sweden)

    L. Punzi

    2011-09-01

    Full Text Available In this review the main stages in the history of intra-articular therapy of the rheumatic diseases are summarized. The first approach to such a local treatment has been likely performed in 1792 by the French physician Jean Gay, who injected in a swelling knee the “eau du Goulard” (Goulard’s water, namely a mixture based on lead compounds. In the XIX century iodine derivatives have been mainly applied as an intra-articular treatment. In the XX century, before the wide use of intra-articular corticosteroids, chiefly due to the Joseph Lee Hollander’s experiences, a variety of drugs has been employed, including cytostatics and sclerosing substances. A further important stage has been synoviorthesis, by using specific radionuclides, that would actually represent an anti-synovial treatment. In the last years a spread use of intra-articular hyaluronic acid, particularly in osteoarthritis, has been recorded, with the aim to warrant articular viscosupplementation. Future of intra-articular treatment should be represented by the biological drugs, i.e., anti-TNF, but it is still untimely to define the exact role of such a local treatment of arthritis.

  16. Espondilodiscitis secundaria a anestesia peridural Spondilodiscitis secondary to peridural anesthesia

    OpenAIRE

    Yvei González Orlandi; Luis Elizondo Barriel; Reinel Junco Martín; Jorge Rojas Manresa; Victor Duboy Limonta; Federico Córdova Armengol

    2010-01-01

    Se presenta el caso de un paciente con espondilodiscitis secundaria al uso de anestesia peridural lumbar para la resección transuretral de una hiperplasia fibroadenomatosa de la próstata. El cuadro clínico estuvo determinado por lumbalgia aguda con incremento progresivo que llevó al confinamiento en cama del paciente. En el examen físico del sistema osteomioarticular predominó la contractura paravertebral lumbar, así como en la palpación de esta región. En el examen neurológico no se encontra...

  17. Intra-articular therapies for osteoarthritis.

    Science.gov (United States)

    Yu, Shirley P; Hunter, David J

    2016-10-01

    Conventional medical therapies for osteoarthritis are mainly palliative in nature, aiming to control pain and symptoms. Traditional intra-articular therapies are not recommended in guidelines as first line therapy, but are potential alternatives, when conventional therapies have failed. Current and future intra-articular drug therapies for osteoarthritis are highlighted, including corticosteroids, hyaluronate, and more controversial treatments marketed commercially, namely platelet rich plasma and mesenchymal cell therapy. Intraarticular disease modifying osteoarthritis drugs are the future of osteoarthritis treatments, aiming at structural modification and altering the disease progression. Interleukin-1β inhibitor, bone morphogenic protein-7, fibroblast growth factor 18, bradykinin B2 receptor antagonist, human serum albumin, and gene therapy are discussed in this review. The evolution of drug development in osteoarthritis is limited by the ability to demonstrate effect. High quality trials are required to justify the use of existing intra-articular therapies and to advocate for newer, promising therapies. Challenges in osteoarthritis therapy research are fundamentally related to the complexity of the pathological mechanisms of osteoarthritis. Novel drugs offer hope in a disease with limited medical therapy options. Whether these future intra-articular therapies will provide clinically meaningful benefits, remains unknown.

  18. Symposium: evidence for the use of intra-articular cortisone or hyaluronic acid injection in the hip

    Science.gov (United States)

    Chandrasekaran, Sivashankar; Lodhia, Parth; Suarez-Ahedo, Carlos; Vemula, S. Pavan; Martin, Timothy J.; Domb, Benjamin G.

    2016-01-01

    The primary purpose of this review article is to discuss the role of diagnostic, corticosteroid, hyaluronic acid (HA) and platelet rich plasma (PRP) in the treatment of osteoarthritis (OA) and femoroacetabular impingement (FIA). These treatments play an important biological role in the non-operative management of these conditions. Two independent reviewers performed an search of PubMed for articles that contained at least one of the following search terms pertaining to intra-articular hip injection—local anaesthetic, diagnostic, ultrasound, fluoroscopic, image guided, corticosteroid, HA, PRP, OA, labral tears and FAI. Seventy-two full text articles were suitable for inclusion. There were 18 articles addressing the efficacy of diagnostic intra-articular hip injections. With respect to efficacy in OA there were 25 articles pertaining to efficacy of corticosteroid, 22 of HA and 4 of PRP. There were three articles addressing the efficacy of biologics in FAI. Diagnostic intra-articular hip injections are sensitive and specific for differentiating between intra-articular, extra-articular and spinal causes of hip symptoms. Ultrasound and fluoroscopy improves the precision of intra-articular positioning of diagnostic injections. Corticosteroids are more effective than HA and PRP in alleviating pain from hip OA. A higher dose of corticosteroids produces a longer benefit but volume of injection has no significant effect. Intra-articular corticosteroids do not increase infection rates of subsequent arthroplasty. There is currently limited evidence to warrant the routine use of therapeutic injections in the management of labral tears and FIA. PMID:27026814

  19. Anestesia volátil e monitorização anestésica.

    OpenAIRE

    Alexandre, Nuno; Costa, Margarida; Mascarenhas, Ramiro

    2009-01-01

    Os autores apresentam um texto de apoio à disciplina de anestesiologia do curso de Medicina Veterinária .Neste texto são abordadas diversas temáticas da anestesia volátil tais como: equipamentos utilizados em anestesia volátil, farmacologia dos anestésicos voláteis. A monitorização dos pacientes é abordada na vertente mecânica ou intrumental e na componente básica.

  20. Intra-articular chondroma of the knee

    Energy Technology Data Exchange (ETDEWEB)

    Talwalkar, S.C.; Kambhampati, S.B.S.; Lang Stevenson, A.I. [Oldchurch Hospital, Romford, Essex (United Kingdom); Whitehouse, R. [Manchester University, Department of Radiology, Manchester (United Kingdom); Freemont, A. [University of Manchester, Department of Osteoarticular Pathology, Manchester (United Kingdom)

    2005-06-01

    Chondromas are tumours that develop in relation to the periosteum and, although they are common around the knee, most reports deal with soft tissue chondromas in para-articular locations or intracortical tumours in extra-articular regions. We report a rare case of an intra-articular chondroma in a 16-year-old boy of Asian origin developing in the region of the medial femoral condyle of the femur and extending into the femoral sulcus and the patellofemoral joint. (orig.)

  1. Intra-articular chondroma of the knee

    International Nuclear Information System (INIS)

    Talwalkar, S.C.; Kambhampati, S.B.S.; Lang Stevenson, A.I.; Whitehouse, R.; Freemont, A.

    2005-01-01

    Chondromas are tumours that develop in relation to the periosteum and, although they are common around the knee, most reports deal with soft tissue chondromas in para-articular locations or intracortical tumours in extra-articular regions. We report a rare case of an intra-articular chondroma in a 16-year-old boy of Asian origin developing in the region of the medial femoral condyle of the femur and extending into the femoral sulcus and the patellofemoral joint. (orig.)

  2. Book review. Anestesia e analgesia locoregionale del cane e del gatto. Francesco Staffieri

    Directory of Open Access Journals (Sweden)

    Manuel Graziani

    2014-03-01

    Full Text Available Il volume di anestesia e analgesia locoregionale del cane e del gatto è pensato per essere un testo "da sala operatoria" – come afferma l'autore – perché consente un rapido, ma allo stesso tempo dettagliato, consulto per il libero professionista che si trova a gestire un'anestesia. Si tratta di un piccolo libro, tascabile, che può essere considerato un punto di partenza per gli studenti e per tutti quei medici veterinari che intendono avvicinarsi in maniera specialistica all'arte dell'anestesiologia veterinaria. L'anestesia locoregionale costituisce, infatti, uno strumento insostituibile per la gestione del dolore perioperatorio in medicina veterinaria. Nel volume si forniscono le nozioni di base per praticare i principali blocchi nervosi centrali e periferici. Per ogni blocco sono riportate le tecniche alla cieca (mediante l'ausilio dei punti di repere anatomici e quelle con l'impiego dello stimolatore nervoso periferico. Il volume, corredato da immagini foto e grafici, per un totale di 65 figure, si apre con i capitoli relativi ai farmaci, agli strumenti e alle complicanze dell'anestesia locoregionale. Prosegue con i blocchi nervosi centrali (anestesia epidurale e spinale e si conclude con i blocchi periferici (testa, arto anteriore, torace, arto posteriore. L'autore, Francesco Staffieri, è un medico veterinario che svolge il dottorato di ricerca nel Dipartimento delle Emergenze e dei Trapianti di Organi, Sezioni di Cliniche Veterinarie e Produzioni Animali dell'Università degli Studi Aldo Moro di Bari.

  3. Bioluminescence imaging of chondrocytes in rabbits by intraarticular injection of D-luciferin

    Energy Technology Data Exchange (ETDEWEB)

    Moon, Sung Min; Min, Jung Joon; Kim, Sung Mi; Bom, Hee Seung [Chonnam National University Medical School, Gwangju (Korea, Republic of); Oh, Suk Jung; Kang, Han Saem; Kim, Kwang Yoon [ECOBIO INC., Gwangju (Korea, Republic of); Kim, Young Ho [College of Natural Science, Chosun University, Gwangju (Korea, Republic of)

    2007-02-15

    Luciferase is one of the most commonly used reporter enzymes in the field of in vivo optical imaging. D-luciferin, the substrate for firefly luciferase has very high cost that allows this kind of experiment limited to small animals such as mice and rats. In this current study, we validated local injection of D-luciferin in the articular capsule for bioluminescence imaging in rabbits. Chondrocytes were cultured and infected by replication-defective adenoviral vector encoding firefly luciferase (Fluc). Chondrocytes expressing Fluc were injected or implanted in the left knee joint. The rabbits underwent optical imaging studies after local injection of D-luciferin at 1, 5, 7, 9 days after cellular administration. We sought whether optimal imaging signals was could be by a cooled CCD camera after local injection of D-luciferin. Imaging signal was not observed from the left knee joint after intraperitoneal injection of D-luciferin (15 mg/kg), whereas it was observed after intraarticular injection. Photon intensity from the left knee joint of rabbits was compared between cell injected and implanted groups after intraarticular injection of D-luciferin. During the period of imaging studies, photon intensity of the cell implanted group was 5-10 times higher than that of the cell injected group. We successfully imaged chondrocytes expressing Fluc after intraarticular injection of D-luciferin. This technique may be further applied to develop new drugs for knee joint disease.

  4. Espondilodiscitis secundaria a anestesia peridural Spondilodiscitis secondary to peridural anesthesia

    Directory of Open Access Journals (Sweden)

    Yvei González Orlandi

    2010-12-01

    Full Text Available Se presenta el caso de un paciente con espondilodiscitis secundaria al uso de anestesia peridural lumbar para la resección transuretral de una hiperplasia fibroadenomatosa de la próstata. El cuadro clínico estuvo determinado por lumbalgia aguda con incremento progresivo que llevó al confinamiento en cama del paciente. En el examen físico del sistema osteomioarticular predominó la contractura paravertebral lumbar, así como en la palpación de esta región. En el examen neurológico no se encontraron alteraciones. La tomografía axial computarizada multicorte, así como la gammagrafía ósea de columna lumbar, confirmaron el diagnóstico. Se indicó tratamiento médico basado en los síntomas, antibioticoterapia combinada y ortesis externa. La recuperación total del paciente ocurrió a los 6 meses del inicio de la enfermedad.This is the case of a patient presenting with spondilodiscitis secondary to use of lumbar peridural anesthesia for transurethral resection of a prostatic fibroadenoma hyperplasia The clinical picture was determined by a acute lumbar pain with a progressive increase leading to put to bed the patient. In physical examination of osteomyoarticular system there was predominance of lumbar paravertebral contracture, as well as in palpation of this region. In neurological examination there weren't alterations. The multi-scan computed axial tomography and the spine column bone scintigraphy confirmed the diagnosis. Medical treatment was prescribed based on symptoms, combined antibiotic drug therapy and external orthesis. The total recovery of patient occurred at 6 months from the onset of disease.

  5. Anestesia en la operación de Fontan

    Directory of Open Access Journals (Sweden)

    Lincoln de la Parte Pérez

    2002-12-01

    Full Text Available La técnica de Fontan ofrece la primera operación fisiológica para la atresia tricuspídea (AT mediante la separación completa de las circulaciones sistémicas y pulmonar. Este proceder se basa en el principio de que la presión en la aurícula derecha es suficiente para garantizar un flujo sanguíneo adecuado a los pulmones, lo que hace innecesaria la función del ventrículo derecho. A partir de su introducción, existe una esperanza para los pacientes con un solo ventrículo y es un procedimiento cada vez más frecuente en el Servicio de Anestesia Cardiovascular. Esta realidad fue el motivo para presentar una revisión bibliográfica actualizada sobre la técnica anestésica que se debe emplear en este procedimiento quirúrgico.Fontan´s technique offers the first physiological operation for tricuspid atresia by complete separation of systemic and pulmonary circulation. This procedure is based on the principle that the right atrium pressure is enough to assure an adequate blood flow to the lungs, which makes the function of right ventricle unnecessary. After the introduction of this procedure, there is a hope for those patients with only one ventricle, therefore, this is an increasingly frequent technique applied in the cardiovascular anesthesia service. Such a reality was the main reason for presenting an updated literature review of the anesthetic technique that should be used in this surgical procedure.

  6. Prótesis fija con anestesia acupuntural Fixed prosthesis with acupuncture anesthesia

    Directory of Open Access Journals (Sweden)

    Marcia Hortensia Corona Carpio

    2006-09-01

    Full Text Available Se presenta un caso de una paciente femenina de 72 años de edad con antecedentes alérgicos a la anestesia dental y preocupación de rehabilitar su estética con prótesis fija. Se decidió aplicar anestesia acupuntural en la preparación de los pilares para recibir el puente fijo. Se exponen las técnicas y los resultados obtenidos. No se manifestaron reacciones adversas. La paciente evolucionó satisfactoriamente con el tratamiento alternativo realizado.

  7. Intra-articular injection of hyaluronic acid for treatment of osteoarthritis knee: comparative study to intra-articular corticosteroids

    Directory of Open Access Journals (Sweden)

    Soad A Elsawy

    2017-01-01

    Conclusion Both HA and corticosteroid groups showed improvement in pain and knee function, but the intra-articular HA was superior to corticosteroid on long-term follow-up. This supports the potential rate of intra-articular HA as an effective long-term therapeutic option for patients with OA of the knee.

  8. An evaluation of the histological effects of intra-articular methadone in the canine model.

    Science.gov (United States)

    Jones, Timothy A; Hand, Walter R; Ports, Michael D; Unger, Daniel V; Herbert, Daniel; Pellegrini, Joseph E

    2003-02-01

    Methadone hydrochloride is an opiate that has pharmacodynamic and pharmacokinetic properties that suggest it may provide longer analgesia than morphine when administered via the intra-articular route. However, no studies to date have been conducted examining the effects of intra-articular methadone hydrochloride on local tissues. Therefore, the purpose of this study was to determine the histopathologic effects of intra-articular methadone hydrochloride on local tissues in the canine knee. Nine canines, 1 to 4 years old, weighing between 20 kg and 23 kg were used. All canines had their knees randomized to receive either bupivacaine, 0.5% with epinephrine 1:200,000 (4.5 mL), and 5 mg methadone hydrochloride (0.5 mL) for the study knee, or bupivacaine, 0.5% with epinephrine 1:200,000 (4.5 mL), and 0.5 mL normal saline for the control knee. Serum methadone hydrochloride levels were obtained on all canines at 6 and 24 hours. Canines were randomly assigned to 1 of 3 groups to be euthanized at either 24 hours, 14 days, or 28 days. Following euthanization and necropsy, synovial fluid levels and tissue samples were obtained and examined for histopathologic changes. Synovial fluid samples noted a few white blood cells at 24 hours and none at 14 and 28 days. Tissue samples showed no histopathologic changes, and serum concentration levels of methadone hydrochloride were negligible.

  9. Are intraarticular steroids effective for knee osteoarthritis?

    Directory of Open Access Journals (Sweden)

    Jorge Faúndez

    2016-12-01

    Full Text Available Resumen La artrosis de rodilla es una enfermedad crónica, invalidante, de evolución progresiva e irreversible. Los corticoides intraarticulares han sido comúnmente utilizados con el fin de disminuir sus síntomas y retrasar la resolución quirúrgica. Sin embargo, hasta el día de hoy, existe debate sobre su eficacia y seguridad. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, se identificaron 12 revisiones sistemáticas que en conjunto incluyen 41 estudios que contestan la pregunta de interés, entre los cuales se cuentan 40 estudios aleatorizados. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que los corticoides intraarticulares probablemente llevan a una leve disminución del dolor a corto plazo, hacen poca o ninguna diferencia a mediano plazo y podrían no tener ningún efecto a largo plazo.

  10. Anestesia en el tronco arterioso común

    Directory of Open Access Journals (Sweden)

    Lincoln de la Parte Pérez

    2003-04-01

    Full Text Available El tronco arterioso es una anomalía congénita del corazón poco frecuente, que se asocia con una alta mortalidad. El 50 % de los pacientes fallece antes de los 3 meses de edad y el 80 % antes del año. La causa más frecuente de muerte es el fallo cardíaco agudo. Presentamos una experiencia en 2 lactantes operados en el Cardiocentro del Hospital Pediátrico Universitario "William Soler", durante el año 2001: una niña de 7 meses de edad, desnutrida, con un tronco común tipo II, hipertensión pulmonar y síndrome de DiGeorge, el segundo paciente era un lactante de 3 meses de edad, con un tronco común tipo I. Se utilizó fentanyl en la inducción y el mantenimiento de la anestesia. La temperatura recta se bajó a 25 °C y los tiempos de circulación extracorpórea fueron de 100 y 121 min y el de pinzamiento aórtico de 30 y 31 min. Se utilizó apoyo farmacológico con dobutrex en dosis bajas. Se emplearon fentanyl, vasodilatadores en infusión continua e hiperventilación, como medidas para evitar la crisis de hipertensión pulmonar. Los enfermos evolucionaron satisfactoriamente durante todo el transoperatorio.The truncus arteriosus is a rare congenital abnormality that is associated with high mortality. 50 % of the patients died before being 3 months old and 80 % before the first year. The most frequent cause of death is acute heart failure. The cases of 3 infants operated on at the Heart Center of William Soler Pediatric Teaching Hospital during 2001 are presented: a seven-old month malnourished girl with a type II common truncus, pulmonary hypertension and DiGiorgio's syndrome, and a 3-month-old female infant with type I common truncus. Fentanyl was used in the induction and maintenance of anesthesia. The straight temperature was lowered to 25 °C, whereas the times of extracorporeal circulation were 100 and 121 min and those of the aortic clamping were 30 and 31 min. Low doses of dobutrex were administered as pharmacological support

  11. Intra-articular osteoid osteoma as a differential diagnosis of diffuse mono-articular joint pain.

    Science.gov (United States)

    Rolvien, Tim; Zustin, Jozef; Mussawy, Haider; Schmidt, Tobias; Pogoda, Pia; Ueblacker, Peter

    2016-11-04

    The aim of this retrospective study was to investigate the frequency of intra-articular osteoid osteoma (iaOO) in a large study cohort and to demonstrate its clinical relevance as an important differential diagnosis of non-specific mono-articular joint pain. We searched the registry for bone tumours of the University Medical Centre Hamburg-Eppendorf for osteoid osteomas in the last 42 years. Herein, we present three selected iaOO which were detected in the three major weight-bearing joints. Computed tomography (CT) or magnetic resonance imaging (MRI) scans were performed for initial diagnosis. Out of a total of 367 osteoid osteomas, 19 (5.2 %) tumours were localized intra-articularly. In all three presented tumours, a history of severe mono-articular pain was reported; however, the mean time to correct diagnosis was delayed to 20.7 months. Clearly, the nidus seen in CT and MRI images in combination with inconsistent salicylate-responsive nocturnal pain led to the diagnosis of iaOO. Rarely, osteoid osteoma can occur in an intra-articular location. In cases of diffuse mono-articular pain, iaOO should be considered both in large and smaller joints to avoid delays in diagnosis and therapy of this benign bone tumour.

  12. A randomized controlled trial of intra-articular prolotherapy versus steroid injection for sacroiliac joint pain.

    Science.gov (United States)

    Kim, Woong Mo; Lee, Hyung Gon; Jeong, Cheol Won; Kim, Chang Mo; Yoon, Myung Ha

    2010-12-01

    Controversy exists regarding the efficacy of ligament prolotherapy in alleviating sacroiliac joint pain. The inconsistent success rates reported in previous studies may be attributed to variability in patient selection and techniques between studies. It was hypothesized that intra-articular prolotherapy for patients with a positive response to diagnostic block may mitigate the drawbacks of ligament prolotherapy. The purpose of this study was to evaluate the efficacy and long-term effectiveness of intra-articular prolotherapy in relieving sacroiliac joint pain, compared with intra-articular steroid injection. This was a prospective, randomized, controlled trial. The study was conducted at an outpatient pain medicine clinic at Chonnam National University Hospital in Gwang-ju, Korea. The study included patients with sacroiliac joint pain, confirmed by ≥50% improvement in response to local anesthetic block, lasting 3 months or longer, and who failed medical treatment. The treatment involved intra-articular dextrose water prolotherapy or triamcinolone acetonide injection using fluoroscopic guidance, with a biweekly schedule and maximum of three injections. Pain and disability scores were assessed at baseline, 2 weeks, and monthly after completion of treatment. The numbers of recruited patients were 23 and 25 for the prolotherapy and steroid groups, respectively. The pain and disability scores were significantly improved from baseline in both groups at the 2-week follow-up, with no significant difference between them. The cumulative incidence of ≥50% pain relief at 15 months was 58.7% (95% confidence interval [CI] 37.9%-79.5%) in the prolotherapy group and 10.2% (95% CI 6.7%-27.1%) in the steroid group, as determined by Kaplan-Meier analysis; there was a statistically significant difference between the groups (log-rank p prolotherapy provided significant relief of sacroiliac joint pain, and its effects lasted longer than those of steroid injections. Further studies

  13. Analgesic effect of intra-articular magnesium sulphate compared with bupivacaine after knee arthroscopic menisectomy

    Directory of Open Access Journals (Sweden)

    Yasser A. Radwan

    2013-07-01

    Full Text Available This work aimed to evaluate the analgesic efficacy of intra-articular injection of magnesium sulphate (4% compared with equivalent volume of bupivacaine (0.5% after outpatient knee arthroscopic meniscectomy. Forty patients were randomly assigned to two groups. Group M (n = 20 received intra-articular magnesium sulphate 4%, group B (n = 20 received bupivacaine (0.5%. Analgesic effect was evaluated by analgesic duration, and by measuring pain intensity at 1, 2, 4, 6, 12, 24 h both at rest and on knee movement to 90°. The primary outcome variable was pain intensity on the VAS at 1, 2, 4, 6, 12, 24 h post arthroscopy at rest and on movement (flexion of knee to 90°, although the magnesium group had lower time weighted averages (TWAs at rest and on movement, these TWAs were not statistically significant. The median duration of postoperative analgesia was significantly longer in the patients treated with magnesium sulphate (528 min than in the bupivacaine group (317 min (p < 0.0001, with less number of patients needing supplementary analgesia in magnesium group (8/20 than those of the bupivacaine group (16/20 (p < 0.022. Also analgesic consumption was significantly lower in the magnesium sulphate group (p < 0.002. We concluded that the use of magnesium sulphate is rational and effective in reducing pain, and is more physiological and shortens convalescence after outpatient arthroscopic meniscectomy, however our hypotheses that analgesic efficacy of intra-articular isotonic magnesium sulphate would be superior to intra-articular local anaesthetic cannot be supported with this study.

  14. Anestesia e o usuário de Ecstasy Anestesia y el usuario de Ecstasy Anesthesia and the Ecstasy user

    Directory of Open Access Journals (Sweden)

    Eduardo Toshiyuki Moro

    2006-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Nos últimos anos o número de novos usuários de agentes ilícitos tem aumentado de forma significativa em todo o mundo. A maconha e a cocaína, além do álcool e do tabaco, têm sido os agentes citados com freqüência, porém houve um aumento significativo de usuários de outros agentes psicoestimulantes ou alucinógenos, como o Ecstasy, o GHB, o LSD e a metanfetamina, empregados com o objetivo de intensificar as experiências sociais. O objetivo do presente artigo foi discutir a apresentação clínica, os efeitos deletérios e as potenciais interações com o ato anestésico no paciente cirúrgico usuário desses agentes ilícitos. CONTEÚDO: O artigo discute os mecanismos de ação, a apresentação clínica, os efeitos deletérios e as possíveis repercussões observadas durante a anestesia no usuário de MDMA (3,4-metilenodioximetanfetamina, também conhecido como Ecstasy. CONCLUSÕES: A apresentação clínica e os efeitos deletérios provocados pelo 3,4-metilenodioximetanfetamina (Ecstasy, assim como potenciais interações com o ato anestésico devem ser do conhecimento do anestesiologista, pois em muitas situações esses usuários serão submetidos a intervenções cirúrgicas de emergência, ou mesmo eletivas.JUSTIFICATIVA Y OBJETIVOS: En los últimos años el número de nuevos usuarios de drogas ilícitas ha aumentado de forma significativa en todo el mundo. La marihuana y la cocaína, además del alcohol y del tabaco, han sido las drogas citadas frecuentemente, sin embargo, hubo un aumento significativo de usuarios de otros agentes psicoestimulantes o alucinógenos, como el Ecstasy, el GHB, el LSD y la metanfetamina, empleados con el objetivo de intensificar las experiencias sociales. El objetivo del presente artículo fue el de traer a colación la presentación clínica, los efectos destructivos y las potenciales interacciones con el acto anestésico en el paciente quirúrgico usuario de esas drogas

  15. Anestesia para obesidade mórbida Anestesia para obesidad mórbida Anesthesia for morbid obesity

    Directory of Open Access Journals (Sweden)

    Michelle Nacur Lorentz

    2007-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A obesidade mórbida é uma doença muito freqüente em nosso meio, enquanto nos EUA já assumiu caráter epidêmico. O paciente obeso apresenta uma série de alterações fisiopatológicas, além de importantes comorbidades, o que exige do anestesiologista pleno conhecimento da fisiopatologia da doença. O procedimento cirúrgico de redução gástrica tem sido cada vez mais realizado e o período perioperatório apresenta características únicas com alterações cardiovascular e pulmonar que o tornam um verdadeiro desafio para os profissionais envolvidos. O hospital também deve estar preparado para receber esses pacientes, com equipamentos adequados, equipe multidisciplinar e cuidados pós-operatórios. O objetivo deste estudo foi demonstrar que o paciente obeso mórbido não é apenas um paciente com excesso de peso, e, portanto, procurou-se nortear as principais condutas a serem observadas. CONTEÚDO: São apresentadas neste artigo as principais alterações fisiopatológicas do obeso mórbido, bem como dados de epidemiologia e doenças correlacionadas. É realizada uma revisão das doses dos medicamentos usados na anestesia, bem como a melhor abordagem pré-, intra- e pós-operatória pelo anestesiologista. CONCLUSÕES: A abordagem do paciente com obesidade mórbida exige um planejamento minucioso que se inicia na seleção dos pacientes, tem continuidade com pré-operatório detalhado e intra-operatório individualizado, e se estende até o pós-operatório, quando a incidência de complicações pulmonar, cardiovascular e infecciosa é maior que na população não-obesa. Para que os resultados sejam favoráveis é extremamente importante o envolvimento de uma equipe multiprofissional que inclui Clínica Geral, Anestesiologia, Cirurgia Geral, Enfermagem, Psicologia, Fisioterapia, Nutrologia e Terapia Intensiva.JUSTIFICATIVA Y OBJETIVOS: La obesidad mórbida es una enfermedad muy frecuente en nuestro medio

  16. Analgesic control after hip arthroscopy: a randomised, double-blinded trial comparing portal with intra-articular infiltration of bupivacaine.

    LENUS (Irish Health Repository)

    Baker, Joseph F

    2011-06-07

    Abstract: The optimum anaesthetic and analgesic management following hip arthroscopy is yet to be determined. There is, in addition, some concern over the use of intraarticular local anaesthetic. We compared the analgesic efficacy of intra-articular infiltration compared with portal infiltration of bupivacaine following hip arthroscopy. Patients were randomised to receive either 10ml of 0.25% bupivacaine either into the joint or around the portal sites following completion of surgery. 73 patients were recruited (40 intra-articular). The portal infiltration group required significantly more rescue analgesia immediately after surgery (2.33mg vs.0.57mg, p=0.036). Visual Analogue Scale pain scores were not significantly different at 1 and 2 hours following surgery, but at 6 hours the portal group had significantly lower VAS scores (p=0.0036). We believe that the initial pain following surgery results from capsular injury and this explains the need for more rescue analgesia in the portal infiltration group. Further work is needed to establish the ideal regimen. A combination of portal and intra-articular infiltration may be the most efficacious.

  17. Anestesia no paciente usuário de cocaína Anestesia en el paciente usuario de cocaína Anesthesia in cocaine users

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    Ana Luft

    2007-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A cocaína é a droga ilícita mais freqüentemente associada a óbitos, e suas implicações perioperatórias nos pacientes agudamente intoxicados ou com história de uso crônico precisam ser bem conhecidas pelos anestesiologistas. O conhecimento da neurofisiologia, da farmacologia e das conseqüências fisiopatológicas decorrentes do uso da cocaína poderá facilitar o cuidado desses pacientes. O objetivo deste trabalho foi revisar as informações sobre a cocaína e suas interações com a anestesia. CONTEÚDO: O artigo discute a farmacologia da cocaína, as conseqüências fisiopatológicas decorrentes do seu uso e as interações com a anestesia. CONCLUSÕES: A compreensão e o reconhecimento precoce das complicações associadas ao uso de cocaína são essenciais para o manuseio adequado de pacientes usuários desta droga. O anestesiologista deve estar preparado, pois tanto as anestesias regionais quanto a geral apresentam riscos significativos nesses pacientes.JUSTIFICATIVA Y OBJETIVOS: La cocaína es la droga ilícita más frecuentemente asociada a decesos, y sus implicaciones perioperatorias en los pacientes agudamente intoxicados o con historial de uso crónico necesitan ser muy bien conocidas por los anestesiólogos. El conocimiento de la neurofisiología, de la farmacología y de las consecuencias fisiopatológicas provenientes del uso de la cocaína podrá facilitar el cuidado de esos pacientes. El objetivo de este trabajo fue revisar las informaciones sobre la cocaína y sus interacciones con la anestesia. CONTENIDO: El artículo discute la farmacología de la cocaína, las consecuencias fisiopatológicas provenientes de su uso y las interacciones con la anestesia. CONCLUSIONES: La comprensión y el reconocimiento precoz de las complicaciones asociadas al uso de la cocaína son esenciales para el manejo adecuado de pacientes usuarios de esa droga. El anestesiólogo debe estar preparado, pues tanto las

  18. Intra-articular corticosteroid for knee osteoarthritis.

    Science.gov (United States)

    Jüni, Peter; Hari, Roman; Rutjes, Anne W S; Fischer, Roland; Silletta, Maria G; Reichenbach, Stephan; da Costa, Bruno R

    2015-10-22

    Knee osteoarthritis is a leading cause of chronic pain, disability, and decreased quality of life. Despite the long-standing use of intra-articular corticosteroids, there is an ongoing debate about their benefits and safety. This is an update of a Cochrane review first published in 2005. To determine the benefits and harms of intra-articular corticosteroids compared with sham or no intervention in people with knee osteoarthritis in terms of pain, physical function, quality of life, and safety. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and EMBASE (from inception to 3 February 2015), checked trial registers, conference proceedings, reference lists, and contacted authors. We included randomised or quasi-randomised controlled trials that compared intra-articular corticosteroids with sham injection or no treatment in people with knee osteoarthritis. We applied no language restrictions. We calculated standardised mean differences (SMDs) and 95% confidence intervals (CI) for pain, function, quality of life, joint space narrowing, and risk ratios (RRs) for safety outcomes. We combined trials using an inverse-variance random-effects meta-analysis. We identified 27 trials (13 new studies) with 1767 participants in this update. We graded the quality of the evidence as 'low' for all outcomes because treatment effect estimates were inconsistent with great variation across trials, pooled estimates were imprecise and did not rule out relevant or irrelevant clinical effects, and because most trials had a high or unclear risk of bias. Intra-articular corticosteroids appeared to be more beneficial in pain reduction than control interventions (SMD -0.40, 95% CI -0.58 to -0.22), which corresponds to a difference in pain scores of 1.0 cm on a 10-cm visual analogue scale between corticosteroids and sham injection and translates into a number needed to treat for an additional beneficial outcome (NNTB) of 8 (95% CI 6 to 13). An I(2) statistic of 68

  19. Estrategias de Control en la Práctica de Anestesia

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    Juan Albino Méndez Pérez

    2011-07-01

    Full Text Available Resumen: Este artículo se centra en el modelado y control de la hipnosis durante la anestesia de pacientes sometidos a intervenciones quirúrgicas. Por un lado en este trabajo se aborda el problema del modelado del proceso presentando resultados validados con pacientes reales. Asimismo, se propone un controlador avanzado para regular el estado hipnótico. El algoritmo empleado se basa en combinar una acción nominal obtenida a partir de la dinámica inversa juntamente con una acción correctora que se obtiene a partir de un controlador predictivo. El trabajo persigue desarrollar una técnica que permita la regulación del estado del paciente y que tenga características de adaptabilidad a los diferentes individuos. Se muestran resultados preliminares de la estrategia propuesta para demostrar la eficiencia del sistema. Palabras clave: Anestesia, BIS, Propofol, Control, Control PID, Control Predictivo, Control Adaptativo

  20. SISTEMA COMPUTARIZADO EN LAZO CERRADO PARA EL SUMINISTRO DE LA ANESTESIA INTRAVENOSA

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    Alberto Vanegas-Saavedra

    2014-12-01

    Full Text Available El sistema de suministro de la anestesia total intravenosa en lazo cerrado es una técnica reciente que ofrece ventajas sobre las técnicas actuales como la estabilidad intraoperatoria y la menor y más segura dosificación. OBJETIVO: El objetivo general de este artículo es el de resumir los hallazgos sobre un nuevo método computarizado sencillo, en lazo cerrado, para suministrar la anestesia total intravenosa de forma automatizada y segura bajo la supervisión permanente del Anestesiólogo. Este sistema se ha desarrollado para la administración de anestesia intravenosa implementando varios subsistemas. Un modelo multicompartimental de distribución de fármacos en el paciente, un algoritmo para determinar la curva de velocidades del hipnótico (propofol a infundir, un protocolo de comunicación para establecer las velocidades de infusión y un lazo de realimentación para controlar la profundidad hipnótica mediante el índice biespectral. RESULTADO: El resultado final ha sido el desarrollo de un instrumento de fácil uso, con una interfaz interactiva, que facilita la operación anestésica por parte del anestesiólogo valiéndose de un computador convencional y un monitor de profundidad hipnótica. CONCLUSIÓN: Se ha implementado una herramienta informática dotada de un modelo farmacocinético multicompartimental de gran interés académico y clínico, que tal y como se ha demostrado de forma cuantitativa, proporciona idénticos resultados a los ofrecidos por equipos comerciales; con importantes ventajas adicionales como una interfaz de usuario interactiva y la posibilidad de administrar anestesia total intravenosa.

  1. Efficacy and safety of combining intra-articular methylprednisolone and anti-TNF agent to achieve prolonged remission in patients with recurrent inflammatory monoarthritis.

    LENUS (Irish Health Repository)

    Haroon, Muhammad

    2012-02-01

    OBJECTIVE: To control local inflammation, the role of intra-articular corticosteroid is well established; similarly, with time there are more reports on the experience of intra-articular anti-TNF agent for localized joint inflammation. The aim of this study was to assess the safety, local tolerability and clinical response after combining intra-articular administration of corticosteroids and anti-TNF agents for recurrent inflammatory monoarthritis. METHODS: Patients with recurrent monoarthritis of the knee were recruited from our inflammatory arthritis clinics. These patients required intra-articular corticosteroids every 8-12 weeks, with good short-term results. Five such consecutive patients were invited to partake in this study. Patients were maintained on their baseline immunosuppressive therapy. After aspiration of knee joint, the involved joint was injected with 80mg of methylprednisolone mixed with 5ml of lignocaine 1%; this was followed by the injection of an anti-TNF agent. RESULTS: In majority of our patients (three out of five), combining anti-TNF agent and methylprednisolone led to prolonged anti-inflammatory response, and these patients remain in remission to date (mean follow-up of 12 months). These responders were noted to be naive to anti-TNF therapy. Conversely, the remaining two patients were found to be on baseline systemic anti-TNF therapy, and both of them failed to respond either partly or completely. CONCLUSION: Combining intra-articular corticosteroid and anti-TNF agent has proved to be safe in our cohort of patients. We conclude that in particular subset of patients who suffer from recurrent inflammatory monoarthritis or oligoarthritis, combination therapy of intra-articular corticosteroids and anti-TNF agents appears attractive and promising.

  2. Local anaesthetics and chondrotoxicty: What is the evidence?

    LENUS (Irish Health Repository)

    Baker, Joseph F

    2012-11-01

    Recent reports have suggested that local anaesthetic agents have a toxic effect on articular chondrocytes. This is despite the widespread intra-articular use of local anaesthetic agents following arthroscopic procedures for a number of years.

  3. Complicações e seqüelas neurológicas da anestesia regional realizada em crianças sob anestesia geral: um problema real ou casos esporádicos? Complicaciones y secuelas neurológicas de la anestesia regional realizada en niños bajo anestesia general: ¿ Un problema real o casos esporádicos? Neurological complications and damage of regional block in children under general anesthesia: a real problem or sporadic cases?

    Directory of Open Access Journals (Sweden)

    Verônica Vieira da Costa

    2006-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Tem sido discutido se a técnica de anestesia regional em crianças, que na maioria das vezes é realizada após a anestesia geral, é realmente segura. Há o risco potencial de uma lesão neurológica permanente ou temporária quando o paciente não pode informar eventual parestesia ou dor, durante a realização da anestesia regional, o que gera insegurança por parte dos anestesiologistas. O objetivo deste estudo foi avaliar a prevalência de complicações e seqüelas neurológicas da anestesia regional em crianças sob anestesia geral. MÉTODO: Numa análise prospectiva foram estudadas crianças submetidas a intervenções cirúrgicas ortopédica e plástica reparadora sob anestesia regional associada à anestesia geral. A indução e a manutenção da anestesia foram por vias venosa ou inalatória. Após anestesia geral era realizada anestesia regional e avaliada a existência de complicações imediatas, o número de punções realizadas, complicações de médio prazo e presença de seqüelas neurológicas. RESULTADOS: Num período de 13 meses foram estudadas 499 crianças de ambos os sexos, com idade média de 6,7 anos. A maioria dos pacientes foi submetida à anestesia geral associada à peridural lombar ou caudal. A prevalência de complicação imediata foi 3,6%, sendo a mais freqüente o sangramento no momento da punção. A prevalência de complicações em médio prazo foi 1,1%, sendo a mais freqüente a hipoestesia e não houve seqüela neurológica de longo prazo. CONCLUSÕES: Os resultados do presente estudo são concordantes com os de outros autores com relação à baixa prevalência de complicações da anestesia regional em crianças sob anestesia geral, sem deixar seqüelas neurológicas. Isso pode ser atribuído ao uso de material adequado e a experiência da equipe de anestesia.JUSTIFICATIVA Y OBJETIVOS: Han sobrevenido discusiones sobre si la técnica de anestesia regional en niños, que en la

  4. Avaliação da memória sob anestesia venosa total

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    Gulistan Aktas

    2013-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Neste estudo, objetivamos avaliar a memória implícita e explícita em pacientes submetidos à cirurgia abdominal sob anestesia venosa total (AVT com propofol e remifentanil, na qual o nível de anestesia foi controlado pelo monitoramento do índice bispectral (BIS. MÉTODO: Anestesia venosa total foi administrada a 60 pacientes adultos para obter níveis de BIS de 40-60. Os pacientes foram randomicamente divididos em três grupos, de acordo com as gravações que ouviram. Os pacientes do grupo categoria (CT ouviram uma fita gravada contendo cinco nomes de animais. Os pacientes do grupo recordar palavras (RP ouviram uma fita gravada contendo cinco palavras de frequência média na língua turca, depois de adaptadas. Os pacientes do grupo controle (GC ouviram os sons do mar até o fim da cirurgia. Duas horas após a cirurgia, os testes foram administrados a cada paciente na sala de recuperação para avaliar a memória. RESULTADOS: Houve uma diferença entre os escores dos grupos CT e GC no Miniexame do Estado Mental (MMSE; todos os escores foram > 20. Os resultados dos testes de categoria e recordar palavras, aplicados para avaliar a memória implícita, não foram estatisticamente diferentes entre os grupos. Não houve evidência de memória implícita em nenhum dos pacientes. Um paciente lembrou-se de ouvir "o som de água" como uma prova de memória explícita. Onze pacientes declararam não ter sonhado. CONCLUSÕES: Apesar de não termos encontrado nenhuma evidência de memória implícita sob anestesia adequada com AVT, um paciente apresentou memória explícita. Embora a profundidade adequada da anestesia fornecida pelo monitoramento do BIS corrobore nossos resultados para a memória implícita, ela não explica os resultados para a memória explícita.

  5. Intra-articular hip injection: does pain relief correlate with radiographic severity of osteoarthritis?

    International Nuclear Information System (INIS)

    Deshmukh, Ajit J.; Rodriguez, Jose A.; Panagopoulos, Georgia; Alizadeh, Ahmadreza; Klein, Devon A.

    2011-01-01

    Intra-articular injection is being used widely for both diagnostic and therapeutic purposes in the hip. However, its efficacy is not always predictable in patients with hip osteoarthritis (OA). The purpose of this study was to determine whether the degree of radiographic severity of OA was predictive of the response to intra-articular injection of local anesthetic with corticosteroid and to determine the relationship between immediate pain relief resulting from the anesthetic and delayed pain relief resulting from corticosteroid administration. This retrospective study included 217 patients (220 injections) with diagnosis of hip OA who underwent a fluoroscopically guided therapeutic hip injection of local anesthetic and corticosteroid. Hip radiographs were scored using the Kellgren-Lawrence scale. Immediate and delayed pain relief was documented using a visual analog scale. Logistic regression analysis was performed to investigate whether age, gender or radiographic severity of OA were independent predictors of pain relief. Degree of agreement between immediate and delayed response was assessed with the kappa coefficient. Immediate pain relief was reported in 68.2% of hips and delayed relief in 71.4% of hips. A high level of agreement was observed between immediate and delayed pain relief (kappa = 0.80, p < 0.001). 94% of patients reporting immediate relief also reported relief 2 weeks later. Univariate and multivariate analysis revealed that neither gender nor age was related to immediate or delayed pain relief. Only severity of OA (based on radiographic analysis) was observed to be predictive of pain relief. Pain relief following intra-articular hip injection correlated with radiographic severity of OA. This intervention may be of therapeutic and prognostic value in patients awaiting hip arthroplasty. (orig.)

  6. Sustained intra-articular release of celecoxib from in situ forming gels made of acetyl-capped PCLA-PEG-PCLA triblock copolymers in horses

    NARCIS (Netherlands)

    Petit, Audrey|info:eu-repo/dai/nl/371748461; Redout, Everaldo M; van de Lest, Chris H|info:eu-repo/dai/nl/146063570; de Grauw, Janny C|info:eu-repo/dai/nl/304822469; Müller, Benno; Meyboom, Ronald; van Midwoud, Paul; Vermonden, Tina|info:eu-repo/dai/nl/275124517; Hennink, Wim E|info:eu-repo/dai/nl/070880409; van Weeren, René|info:eu-repo/dai/nl/074628550

    In this study, the intra-articular tolerability and suitability for local and sustained release of an in situ forming gel composed of an acetyl-capped poly(ε-caprolactone-co-lactide)-b-poly(ethylene glycol)-b-poly(ε-caprolactone-co-lactide) (PCLA-PEG-PCLA) copolymer loaded with celecoxib was

  7. Postarthroscopy analgesia using intraarticular levobupivacaine and intravenous dexketoprofen trometamol.

    Science.gov (United States)

    Sahin, Sevtap Hekimoglu; Memiş, Dilek; Celik, Erkan; Sut, Necdet

    2015-12-01

    The aim of this prospective study was to determine the efficacy of intraarticular levobupivacaine with and without intravenous dexketoprofen trometamol for postarthroscopy analgesia. Sixty patients who underwent arthroscopic knee surgery were randomly assigned to three treatment groups. When the surgical procedure was completed, patients received the following treatments: group I (n = 20) patients received 20 mL intraarticular normal saline and 2 mL intravenous dexketoprofen trometamol (50 mg); group II (n = 20) patients received 20 mL intraarticular 0.5 % levobupivacaine (100 mg) and 2 mL intravenous normal saline; and group III (n = 20) patients received 20 mL intraarticular 0.5 % levobupivacaine (100 mg) and 2 mL intravenous dexketoprofen trometamol (50 mg). The visual analogue scale (VAS) was used, and the total analgesic consumption was assessed at 1, 2, 4, 6, 12, and 24 h post-operatively. The VAS scores at 1, 2, 4, 6, 12, and 24 h post-operatively were significantly increased in group I and group II compared with group III (p dexketoprofen trometamol administration provided better pain relief and less analgesic requirement after arthroscopic knee surgery during the first 24 h than that induced by dexketoprofen alone or levobupivacaine intraarticular alone. II.

  8. Intraarticular volume and clearance in human synovial effusions

    International Nuclear Information System (INIS)

    Wallis, W.J.; Simkin, P.A.; Nelp, W.B.; Foster, D.M.

    1985-01-01

    Intraarticular volumes were measured by radiolabeled albumin (RISA) distribution in chronic knee effusions from 11 rheumatoid arthritis patients and 9 osteoarthritis patients. Volumes of synovial fluid obtained at joint aspiration were substantially less than those found by RISA dilution. Up to 24 hours was needed for full distribution of RISA throughout the intraarticular compartment. Measured 123I and RISA radioactivity over the knee described monoexponential rate constants, lambda (minute-1). The clearance of 123I and RISA from synovial effusions was derived by the formulation volume (ml) X lambda (minute-1) = clearance (ml/minute). RISA clearance in rheumatoid effusions was significantly greater than that found in osteoarthritis effusions. Intraarticular volume and isotope clearance were easily quantified and provide measures for further evaluating the microvascular physiology of synovial effusions

  9. Intra-Articular Osteotomy for Distal Humerus Malunion

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    René K. Marti

    2009-01-01

    Full Text Available Intra-articular osteotomy is considered in the rare case of malunion after a fracture of the distal humerus to restore humeral alignment and gain a functional arc of elbow motion. Traumatic and iatrogenic disruption of the limited blood flow to the distal end of the humerus resulting in avascular necrosis of capitellum or trochlea is a major pitfall of the this technically challenging procedure. Two cases are presented which illustrate the potential problems of intra-articular osteotomy for malunion of the distal humerus.

  10. Intra-articular lignocaine as a means of analgesia during manual reduction of acute anterior shoulder dislocation

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    Manoj Kadel

    2016-11-01

    Full Text Available Background & Objectives: Acute anterior shoulder dislocation needs prompt reduction of the dislocation. The ideal reduction method should be simple, fast, effective and non- traumatic, with minimal pain, and should not cause further injury to the affected shoulder. Intra-articular local lignocaine injection is a means of achieving analgesia with less complication, and allowing prompt patient discharge of patient after reduction. The study was conducted with objective to evaluate the effectiveness of intra-articular lignocaine for reduction of acute anterior shoulder dislocation.Materials & Methods: Twenty- one cases of acute anterior shoulder dislocation were reduced using intra-articular local lignocaine injection as a method of analgesia by modified Hippocrates method.Results: The mean age was 44.71 years ± SD 20.14 while 11 cases were reduced with one to six hours of injury. Pain assessed through application of a visual analogue scale during the maneuver revealed scores ranging from two to eight with mean score of 4.29 ± SD 1.55.Conclusion: This method is not only safe and effective but also reduces hospital stay and has negligible adverse effects making it a popular choice for most orthopedists.

  11. Intra-articular nerve growth factor regulates development, but not maintenance, of injury-induced facet joint pain & spinal neuronal hypersensitivity.

    Science.gov (United States)

    Kras, J V; Kartha, S; Winkelstein, B A

    2015-11-01

    The objective of the current study is to define whether intra-articular nerve growth factor (NGF), an inflammatory mediator that contributes to osteoarthritic pain, is necessary and sufficient for the development or maintenance of injury-induced facet joint pain and its concomitant spinal neuronal hyperexcitability. Male Holtzman rats underwent painful cervical facet joint distraction (FJD) or sham procedures. Mechanical hyperalgesia was assessed in the forepaws, and NGF expression was quantified in the C6/C7 facet joint. An anti-NGF antibody was administered intra-articularly in additional rats immediately or 1 day following facet distraction or sham procedures to block intra-articular NGF and test its contribution to initiation and/or maintenance of facet joint pain and spinal neuronal hyperexcitability. NGF was injected into the bilateral C6/C7 facet joints in separate rats to determine if NGF alone is sufficient to induce these behavioral and neuronal responses. NGF expression increases in the cervical facet joint in association with behavioral sensitivity after that joint's mechanical injury. Intra-articular application of anti-NGF immediately after a joint distraction prevents the development of both injury-induced pain and hyperexcitability of spinal neurons. Yet, intra-articular anti-NGF applied after pain has developed does not attenuate either behavioral or neuronal hyperexcitability. Intra-articular NGF administered to the facet in naïve rats also induces behavioral hypersensitivity and spinal neuronal hyperexcitability. Findings demonstrate that NGF in the facet joint contributes to the development of injury-induced joint pain. Localized blocking of NGF signaling in the joint may provide potential treatment for joint pain. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  12. Anestesia e síndrome do QT longo Anestesia e síndrome del QT largo Anesthesia and the long QT syndrome

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    Michelle Nacur Lorentz

    2007-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: As disritmias cardíacas são fatores importantes de morbimortalidade no período perioperatório. Dentre as causas de disritmias, a síndrome do QT longo, tanto em sua forma genética como adquirida deve ser lembrada, já que muitos fármacos usados em anestesia, bem como ocorrências no período perioperatório podem prolongar o intervalo QT e precipitar disritmias cardíacas potencialmente malignas. CONTEÚDO: Revisão da síndrome do QT longo (LQTS, abordando suas causas e sua definição, assim como os mecanismos da doença. Além de citar vários fármacos implicados no prolongamento do intervalo QT, as abordagens anestésicas mais adequadas para os pacientes afetados são sugeridas. CONCLUSÃO: A síndrome do QT longo, possível causa de morbimortalidade intra e pós-operatória, pode estar relacionada com fármacos utilizados durante anestesia. Essa condição demanda conhecimento do anestesiologista a fim de evitar desfecho desfavorável do ato operatório.JUSTIFICATIVA Y OBJETIVOS: Las arritmias cardíacas son factores importantes de morbi mortalidad en el período perioperatorio. Entre las causas de arritmias, el síndrome del QT largo, tanto en su forma genética como adquirida debe ser recordado ya que muchos fármacos usados en anestesia, e incidencias en el período perioperatorio pueden prolongar el intervalo QT y precipitar arritmias potencialmente malignas. CONTENIDO: Revisión del Síndrome del QT largo (LQTS, abordando sus causas y definición, y los mecanismos de la enfermedad. Además de citar varios fármacos implicados en el prolongamiento del intervalo QT, los abordajes anestésicos más adecuadas para los pacientes afectados son sugeridas. CONCLUSIÓN: El síndrome del QT largo, posible causa de morbimortalidad intra y postoperatoria, puede estar relacionada a fármacos utilizados durante anestesia. Esa condición demanda conocimiento del anestesiólogo para evitar un desenlace no deseado de

  13. Anestesia subaracnóidea em crianças Anestesia subaracnóidea en niños Spinal anesthesia in children

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    Norma Sueli Pinheiro Módolo

    2001-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Tem aumentado muito o emprego da anestesia subaracnóidea em crianças, principalmente neonatos com risco de desenvolver apnéia neonatal. O objetivo deste trabalho foi rever as diferenças anatômicas, fisiológicas e farmacológicas desta técnica em crianças. CONTEÚDO: A anestesia subaracnóidea em crianças, apesar de ter sido técnica empregada desde o início do século XX, teve sua popularidade diminuída com o advento dos anestésicos inalatórios e bloqueadores neuromusculares, para ser novamente resgatada em 1979. As características favoráveis desta técnica em pediatria são relativas à estabilidade cardiovascular, em crianças de até 8 anos de idade, à analgesia satisfatória e ao relaxamento muscular. Os anestésicos mais utilizados em crianças são a tetracaína e a bupivacaína, cujas doses são ajustadas tomando-se por base o peso corporal. Esta técnica é limitada pela duração relativamente curta, devendo ser utilizada para procedimentos cirúrgicos que não ultrapassem 90 minutos e também pela analgesia não abranger o pós-operatório. As complicações são as mesmas encontradas no paciente adulto, incluindo cefaléia por punção dural e irritação radicular transitória. As indicações são várias: cirurgias de abdômen inferior, genitália, membros inferiores, região perineal e, em alguns casos, até em cirurgias torácicas. Seu emprego tem particular interesse nos recém-nascidos prematuros, pelo risco de apresentarem a apnéia da prematuridade. CONCLUSÕES: A anestesia subaracnóidea em crianças é técnica relativamente segura, com poucas complicações e pode ser considerada como opção para anestesia geral, principalmente nos recém-nascidos prematuros com risco de apresentarem complicações respiratórias no pós-operatório.JUSTIFICATIVA Y OBJETIVOS: Ha aumentado mucho el empleo de la anestesia subaracnóidea en niños, principalmente neonatos con riesgo de desarrollar

  14. Anestesia venosa total para timectomia em paciente com Miastenia Gravis: relato de caso

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    Rezer Gabrielle

    2003-01-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Pacientes com doenças neuromusculares, como Miastenia Gravis, respondem de maneira anormal aos anestésicos, conforme a técnica e as drogas administradas. O objetivo deste relato é mostrar um caso de paciente portadora de Miastenia Gravis, submetida a timectomia sob anestesia venosa total com propofol e remifentanil. RELATO DO CASO: Paciente feminina, 52 anos, 72 kg, com história de Miastenia Gravis submetida a timectomia transesternal, sob anestesia venosa total, com o uso de propofol em infusão alvo controlada (3 g.ml-1 e remifentanil contínuo (0,3 µg.kg-1.min-1. Para a intubação traqueal foi utilizada succinilcolina (50 mg, sendo realizada sem dificuldade. Com a finalidade de realizar a analgesia pós-operatória, foram utilizados tramadol (50 mg, cetoprofeno (100 mg e dipirona (1 g, no per-operatório. Após a cirurgia, a infusão de propofol e remifentanil foi encerrada e, 15 minutos depois, a paciente foi extubada. A paciente apresentava-se eupnéica, acordada, sem dor, movimentando membros, com freqüência respiratória de 14 mpm e mantendo saturação de oxigênio de 97%. Permaneceu com cateter nasal de O2 a 2 L.min-1 na UTI intermediária, durante 36 horas, e recebeu alta hospitalar no 4º dia do pós-operatório. CONCLUSÕES: A anestesia venosa total, com agentes anestésicos de curta duração e sem metabólitos ativos, favoreceu a recuperação e a extubação precoce da paciente

  15. Efeitos fetais e maternos do propofol, etomidato, tiopental e anestesia epidural, em cesariana eletivas de cadelas

    Directory of Open Access Journals (Sweden)

    Lavor Mário Sérgio Lima de

    2004-01-01

    Full Text Available O objetivo deste trabalho foi comparar os efeitos entre os fármacos indutores de anestesia como propofol, etomidato e tiopental, e a anestesia epidural com lidocaína seguida de indução, em cadelas submetidas à cesariana, e seus neonatos. Para tanto, foram utilizadas 20 cadelas e 129 filhotes distribuídos em quatro grupos. No grupo 1 (5 cadelas e 39 neonatos, a indução anestésica foi feita com propofol; no grupo 2 (5 cadelas e 25 neonatos, com etomidato; no grupo 3 (5 cadelas e 26 neonatos com tiopental e no grupo 4, (5 cadelas e 39 neonatos utilizou-se anestesia epidural e indução com halotano através de máscara. Em todos os casos, a medicação pré-anestésica foi feita com midazolam na dose de 0,22mg kg-1 via IM, e a manutenção anestésica com halotano em circuito semifechado e concentração inicial de 3V%. As variáveis avaliadas nas cadelas foram: temperatura retal, freqüência cardíaca, freqüência respiratória, saturação da oxi-hemoglobina (SpO2, pressão arterial média. Para a avaliação dos recém-nascidos, foram mensurados: freqüência cardíaca, esforço respiratório, movimentos musculares, coloração das mucosas e irritabilidade reflexa interpretados através do escore de Apgar modificado, bem como a SpO2 do neonato. Os resultados mostraram que todos os protocolos foram adequados para as mães com mínimos efeitos sistêmicos. Para o neonato, a utilização de anestesia epidural na mãe, seguida de indução e manutenção com halotano foi superior aos protocolos que usaram agentes injetáveis na indução anestésica.

  16. Anestesia em paciente com síndrome de Rubinstein-Taybi: relato de caso

    OpenAIRE

    Oliveira, Carlos Rogério Degrandi; Elias, Luciana

    2005-01-01

    JUSTIFICATIVA E OBJETIVOS: A síndrome de Rubinstein-Taybi (SRT) é uma doença genética causada por uma mutação ou apagamento do cromossomo 16, caracterizada por retardo físico e mental, anormalidades craniofaciais e hálux e polegares largos. Há pouca informação sobre esta síndrome na literatura anestésica. O objetivo deste relato foi apresentar a conduta anestésica em paciente submetido à cirurgia odontológica e discutir as características de interesse para a anestesia nesses pacientes. RELATO...

  17. Complicações respiratórias em pacientes com paralisia cerebral submetidos à anestesia geral

    OpenAIRE

    Mello, Sérgio Silva de; Marques, Ronaldo Soares; Saraiva, Renato Ângelo

    2007-01-01

    JUSTIFICATIVA E OBJETIVOS: Anestesia em pacientes com paralisia cerebral (PC) pode representar um desafio para o anestesiologista. Este estudo prospectivo teve como objetivo determinar a prevalência e o risco de complicações respiratórias em crianças com PC submetidas à anestesia geral inalatória (AGI) para tomografia computadorizada (TC). MÉTODO: Participaram do estudo pacientes com idades entre 1 e 17 anos, estado físico ASA I a III, submetidos a AGI com sevoflurano e máscara laríngea para ...

  18. Peroneal tendon displacement accompanying intra-articular calcaneal fractures.

    Science.gov (United States)

    Toussaint, Rull James; Lin, Darius; Ehrlichman, Lauren K; Ellington, J Kent; Strasser, Nicholas; Kwon, John Y

    2014-02-19

    Peroneal tendon displacement (subluxation or dislocation) accompanying an intra-articular calcaneal fracture is often undetected and under-treated. The goals of this study were to determine (1) the prevalence of peroneal tendon displacement accompanying intra-articular calcaneal fractures, (2) the association of tendon displacement with fracture classifications, (3) the association of tendon displacement with heel width, and (4) the rate of missed diagnosis of the tendon displacement on radiographs and computed tomography (CT) scans and the resulting treatment rate. A retrospective radiographic review of all calcaneal fractures presenting at three institutions from June 30, 2006, to June 30, 2011, was performed. CT imaging of 421 intra-articular calcaneal fractures involving the posterior facet was available for review. The prevalence of peroneal tendon displacement was noted and its associations with fracture classification and heel width were evaluated. Peroneal tendon displacement was identified in 118 (28.0%) of the 421 calcaneal fracture cases. The presence of tendon displacement was significantly associated with joint-depression fractures compared with tongue-type fractures (p displacement had been identified in the radiology reports. Although sixty-five (55.1%) of the fractures with tendon displacement had been treated with internal fixation, the tendon displacement was treated surgically in only seven (10.8%) of these cases. Analysis of CT images showed a 28% prevalence of peroneal tendon displacement accompanying intra-articular calcaneal fractures. Surgeons and radiologists are encouraged to consider this association.

  19. Intra-articular lipoma causing snapping in the patellofemoral joint

    International Nuclear Information System (INIS)

    Yilmaz, E.; Karakurt, L.; Yildirim, H.; Ozercan, R.

    2007-01-01

    Intra-articular lipoma is an exceedingly rare diagnosis. We identified a lipoma that was seated in the retropatellar are and caused snapping of the patella during flexion of the knee joint. The tumor was easily and totally excised under arthroscopic guidance after the thin pedicle was cut. (author)

  20. Clinical outcome scoring of intra-articular calcaneal fractures

    NARCIS (Netherlands)

    Schepers, Tim; Heetveld, Martin J.; Mulder, Paul G. H.; Patka, Peter

    2008-01-01

    Outcome reporting of intra-articular calcaneal fractures is inconsistent. This study aimed to identify the most cited outcome scores in the literature and to analyze their reliability and validity. A systematic literature search identified 34 different outcome scores. The most cited outcome score

  1. Clinical Outcome Scoring of Intra-articular Calcaneal Fractures

    NARCIS (Netherlands)

    T. Schepers (Tim); M.J. Heetveld (Martin); P.G.H. Mulder (Paul); P. Patka (Peter)

    2008-01-01

    textabstractOutcome reporting of intra-articular calcaneal fractures is inconsistent. This study aimed to identify the most cited outcome scores in the literature and to analyze their reliability and validity. A systematic literature search identified 34 different outcome scores. The most cited

  2. Intra-articular osteotomy for distal humerus malunion

    NARCIS (Netherlands)

    Marti, René K.; Doornberg, Job

    2009-01-01

    Intra-articular osteotomy is considered in the rare case of malunion after a fracture of the distal humerus to restore humeral alignment and gain a functional arc of elbow motion. Traumatic and iatrogenic disruption of the limited blood flow to the distal end of the humerus resulting in avascular

  3. Juvenile chronic arthritis: imaging of the knees and hips before and after intraarticular steroid injection

    Energy Technology Data Exchange (ETDEWEB)

    Eich, G.F. [Div. of Diagnostic Imaging and Radiology, Univ. Children`s Hospital, Zuerich (Switzerland); Halle, F. [Div. of Immunology and Hematology, Univ. Children`s Hospital, Zuerich (Switzerland); Hodler, J. [Div. of Radiology, Balgrist Orthopedic Univ. Clinic, Zuerich (Switzerland); Seger, R. [Div. of Immunology and Hematology, Univ. Children`s Hospital, Zuerich (Switzerland); Willi, U.V. [Div. of Diagnostic Imaging and Radiology, Univ. Children`s Hospital, Zuerich (Switzerland)

    1994-12-01

    Intraarticular steroid therapy in juvenile chronic arthritis (JCA) is performed because of high local efficacy with few side effects. Imaging is used for initial evaluation and for monitoring of treatment response. The aim of this study was to compare imaging findings in diseased hips and knees before and after therapy. A prospective study was performed on 10 patients (15 joints) scheduled for intraarticular therapy. Pretherapeutic assessment included clinical work-up, radiographs, ultrasound (US), and magnetic resonance imaging (MRI) of affected joints. Following therapy, clinical and sonographic examinations were performed at 1 week and 1 month. MRI was repeated at 1 month. MRI and US demonstrated pannus formation and effusion, but differentiation was less distinct on US. Popliteal cysts and lymph nodes were visible in both modalities. MRI additionally revealed articular cartilage loss and subchondral cysts, not shown by US. Epiphyseal overgrowth and osteopenia were best seen radiographically. At present MRI is the best tool to assess the inflammatory changes of the joints in JCA. Initial staging of the joints may be done with plain films and MRI. US is useful to assess effusion and pannus and may be used to monitor treatment response. (orig.)

  4. Juvenile chronic arthritis: imaging of the knees and hips before and after intraarticular steroid injection

    International Nuclear Information System (INIS)

    Eich, G.F.; Halle, F.; Hodler, J.; Seger, R.; Willi, U.V.

    1994-01-01

    Intraarticular steroid therapy in juvenile chronic arthritis (JCA) is performed because of high local efficacy with few side effects. Imaging is used for initial evaluation and for monitoring of treatment response. The aim of this study was to compare imaging findings in diseased hips and knees before and after therapy. A prospective study was performed on 10 patients (15 joints) scheduled for intraarticular therapy. Pretherapeutic assessment included clinical work-up, radiographs, ultrasound (US), and magnetic resonance imaging (MRI) of affected joints. Following therapy, clinical and sonographic examinations were performed at 1 week and 1 month. MRI was repeated at 1 month. MRI and US demonstrated pannus formation and effusion, but differentiation was less distinct on US. Popliteal cysts and lymph nodes were visible in both modalities. MRI additionally revealed articular cartilage loss and subchondral cysts, not shown by US. Epiphyseal overgrowth and osteopenia were best seen radiographically. At present MRI is the best tool to assess the inflammatory changes of the joints in JCA. Initial staging of the joints may be done with plain films and MRI. US is useful to assess effusion and pannus and may be used to monitor treatment response. (orig.)

  5. Intraoperative intra-articular injection of gentamicin: will it decrease the risk of infection in total shoulder arthroplasty?

    Science.gov (United States)

    Lovallo, Jeffrey; Helming, Jarrett; Jafari, S Mehdi; Owusu-Forfie, Afia; Donovan, Skye; Minnock, Christopher; Adib, Farshad

    2014-09-01

    Deep infection is a debilitating complication after shoulder arthroplasty. Intra-articular injection of antibiotic can give a higher concentration compared with intravenous administration. We hypothesized that a group of patients given an intra-articular, intraoperative injection of gentamicin would report a lower infection rate than a group without local antibiotics. Between 2005 and 2011, the senior author performed 507 shoulder arthroplasties. We retrospectively reviewed all of those cases. All patients were administered systemic prophylactic antibiotics. Beginning in June 2007, patients were also injected with 160 mg of gentamicin in the glenohumeral joint at the end of their surgery. Patient records were examined for preexisting medical conditions, type of surgery, and presence of infection. Patients receiving surgery before 2007 were compared with those after to determine the effect of prophylactic gentamicin administration in preventing deep infection associated with surgery. All patients were observed for a minimum of 1 year. Of the 507 surgeries, 164 were performed before 2007 (without intra-articular injection of gentamicin; group A) and 343 were performed with addition of gentamicin (group B). In group A, 5 patients presented with infection (3.0%) compared with 1 in group B (0.29%). The gender, mean age, mean body mass index, and prevalence of comorbidities were similar between the groups. The data from this study support the conclusion that intra-articular intraoperative gentamicin administration may reduce postoperative infection. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  6. Comparison of analgesic effect of intra-articular administration of levobupivacaine and clonidine versus ropivacaine and clonidine in day care knee arthroscopic surgery under spinal anesthesia

    Directory of Open Access Journals (Sweden)

    Sudeshna Senapati

    2016-01-01

    Full Text Available Introduction: Intra-articular (IA local anesthetics are often used for the management and prevention of pain after arthroscopic knee surgery. Clonidine prolongs the duration of local anesthetics. In this study, analgesic effect of intra-articular administration of levobupivacaine and clonidine was compared with ropivacaine and clonidine in knee joint arthroscopic surgery under spinal anesthesia. Method: 88 patients, aged between 15 to 55 years, ASA I and II undergoing knee arthroscopy under spinal anesthesia were assigned into two equal groups (n = 44 in a randomized double blind protocol. Patients in Group L received 10 ml of 0.50% levobupivacaine and 1 mcg/kg clonidine and Group R received 10 ml of 0.75% ropivacaine and 1 mcg/kg of clonidine through intra-articular route at the end of the procedure. In the post-operative period, pain intensity was assessed by VAS (Visual Analogue Scale Score recorded at 1 st , 5 th , 8 th , 12 th , 18 th post-operative hours. Duration of analgesia, total rescue analgesic dose in first 18 hours and any side effects were also recorded. Result: Group L experienced significantly longer duration of effective postoperative analgesia and lesser rescue analgesic compared to group R. Group R had higher mean VAS score at 5 th and 12 th post-operative hours (P < 0.05. No side effects were observed among the groups. Conclusion: Intra-articular administration of levobupivacaine and clonidine give better post-operative pain relief by increasing duration of analgesia, and decreasing need of rescue analgesic compared to intra-articular ropivacaine and clonidine.

  7. Anestesia general para cesárea. Papel del sugammadex en la calidad y la seguridad del acto anestésico. Reporte de caso

    OpenAIRE

    Tafur B, Luis Alberto; Lema Flórez, Eduardo

    2012-01-01

    La cesárea es una de las intervenciones quirúrgicas más realizadas en el planeta. En el 5% de los casos se practica bajo anestesia general (7,5 millones de anestesias generales para cesárea cada año). Debido a sus requerimientos particulares (paciente con estómago lleno, necesidad de relajación neuromuscular, bienestar del binomio madre-hijo, expectativas de pronta atención del recién nacido por parte de la madre y relativa corta duración del procedimiento) la anestesia general representa un ...

  8. Hipertensão arterial sistêmica e anestesia Hipertensión arterial sistémica y anestesia Systemic hypertension and anesthesia

    Directory of Open Access Journals (Sweden)

    Michelle Nacur Lorentz

    2005-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Devido à grande prevalência da hipertensão arterial sistêmica na população e a falta de consenso sobre que níveis pressóricos o anestesiologista deve aceitar para induzir uma anestesia para cirurgia eletiva, realizou-se uma revisão na literatura que trata da associação hipertensão arterial e anestesia. Considerando que a suspensão de uma cirurgia implica em gastos, o que torna a Medicina cada vez mais cara, e que, por outro lado, o ato anestésico deve ser realizado com a maior segurança possível, o objetivo desse trabalho foi analisar as evidências da literatura que possam nortear a prática clínica. CONTEÚDO: O artigo apresenta incidência e classificação da hipertensão arterial sistêmica além de relatar e comentar trabalhos relevantes que abordam a hipertensão arterial no paciente cirúrgico. CONCLUSÕES: Ainda não estão estabelecidos quais níveis máximos de pressão são compatíveis com uma cirurgia eletiva, sendo que, atualmente, os critérios para a suspensão da cirurgia no paciente hipertenso mal controlado são muito mais baseados em dados empíricos que em evidências. Existe uma tendência em postergar a cirurgia quando a PA é superior a 180/110 mmHg, mas cada caso deve ser analisado isoladamente, valorizando mais lesões em órgãos alvo que a pressão arterial propriamente dita.JUSTIFICATIVA Y OBJETIVOS: Debido a la grande superioridad de la hipertensión arterial sistémica en la población y la falta de acuerdo sobre que niveles presóricos el anestesiologista debe aceptar para inducir una anestesia para cirugía electiva, se realizó una revisión en la literatura que trata de la asociación hipertensión arterial y anestesia. Considerando que la suspensión de una cirugía implica en gastos, lo que hace la Medicina cada vez más cara, y que, por otro lado, el acto anestésico debe ser realizado con la mayor seguridad posible, la finalidad de ese trabajo fue analizar las

  9. Anestesia em paciente com Distrofia Muscular de Duchenne: relato de caso

    Directory of Open Access Journals (Sweden)

    Tonelli Deoclécio

    2003-01-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A distrofia muscular de Duchenne é uma afecção recessiva ligada ao cromossomo X, geralmente diagnosticada na infância, acentuando-se progressivamente até agravar a função respiratória. O objetivo deste relato é apresentar um caso de um paciente com distrofia muscular de Duchenne diagnosticada há 2 anos, submetido à postectomia, sob anestesia geral com cetamina S. RELATO DO CASO: Paciente com 9 anos de idade com Distrofia Muscular de Duchenne diagnosticada há 2 anos, submetido à anestesia geral com levo-cetamina (1,5 mg.kg-1, por via venosa, sob ventilação espontânea assistida manualmente por sistema de Baraka (Mapleson A e bloqueio peniano com bupivacaína a 0,5% (25 mg. Foram usados monitores de pressão arterial não invasiva, oximetria de pulso, cardioscopia e temperatura esofagiana. No decorrer da cirurgia, o caso evoluiu sem intercorrências, sendo que no período pós-operatório o paciente apresentou alguns episódios de vômitos sem outras alterações significativas. Permaneceu internado por 24 horas, tendo alta hospitalar assintomático. CONCLUSÕES: A avaliação pré-anestésica cuidadosa, o uso de monitorização adequada e medicações que não predisponham o aparecimento de complicações tornam seguro o procedimento em pacientes portadores de Distrofia Muscular de Duchenne e seu pós-operatório.

  10. Early osteoarthritis and microdialysis: a novel in vivo approach for measurements of biochemical markers in the perisynovium and intraarticularly

    DEFF Research Database (Denmark)

    Helmark, Ida Carøe; Mikkelsen, U R; Krogsgaard, M R

    2010-01-01

    The microdialysis technique was evaluated as a possible method to obtain local measurements of biochemical markers from knee joints with degenerative changes. Seven patients scheduled for arthroscopy of the knee due to minor to moderate degenerative changes had microdialysis catheters inserted...... under ultrasonographic guidance, intraarticularly and in the synovium-close tissue. Catheters were perfused at a rate of 2 μl/min for approximately 100 min with a Ringer solution containing radioactively labeled glucose, and the positions of the catheters were later visualized during arthroscopy. All...

  11. Comparison of hyaluronic acid and PRP intra-articular injection with combined intra-articular and intraosseous PRP injections to treat patients with knee osteoarthritis.

    Science.gov (United States)

    Su, Ke; Bai, Yuming; Wang, Jun; Zhang, Haisen; Liu, Hao; Ma, Shiyun

    2018-05-01

    The aim of this study was to evaluate the benefit provided by intraosseous infiltration combined with intra-articular injection of platelet-rich plasma to treat mild and moderate stages of knee joint degeneration (Kellgren-Lawrence score II-III) compared with other treatments, specifically intra-articular injection of PRP and of HA. Eighty-six patients with grade II to grade III knee OA according to the Kellgren-Lawrence classification were randomly assigned to intra-articular combined with intraosseous injection of PRP (group A), intra-articular PRP (group B), or intra-articular HA (group C). Patients in group A received intra-articular combined with intraosseous injection of PRP (administered twice, 2 weeks apart). Patients in group B received intra-articular injection of PRP every 14 days. Patients in group C received a series of five intra-articular injections of HA every 7 days. All patients were evaluated using the Visual Analogue Scale (VAS) and Western Ontario and McMaster Universities (WOMAC) score before the treatment and at 1, 3, 6, 12, and 18 months after treatment. There were significant improvements at the end of the 1st month. Notably, group A patients had significantly superior VAS and WOMAC scores than were observed in groups B and C. The VAS scores were similar in groups B and group C after the 6th month. Regarding the WOMAC scores, groups B and C differed at the 1st, 3rd, 6th, and 12th months; however, no significant difference was observed at the 18th month. The combination of intraosseous with intra-articular injections of PRP resulted in a significantly superior clinical outcome, with sustained lower VAS and WOMAC scores and improvement in quality of life within 18 months.

  12. Intraarticular glucocorticoid, morphine and bupivacaine reduces pain and convalescence after arthroscopic ankle surgery: a randomized study of 36 patients

    DEFF Research Database (Denmark)

    Rasmussen, S; Kehlet, H

    2000-01-01

    In a double-blind randomized study, 36 patients undergoing arthroscopic removal of bony spurs and synovitis causing impingement of the ankle were allocated to intraarticular saline or bupivacaine 15 mg + morphine 5 mg + intraarticular methylprednisolone 40 mg. Combined methylprednisolone, bupivac......In a double-blind randomized study, 36 patients undergoing arthroscopic removal of bony spurs and synovitis causing impingement of the ankle were allocated to intraarticular saline or bupivacaine 15 mg + morphine 5 mg + intraarticular methylprednisolone 40 mg. Combined methylprednisolone...

  13. Intraarticular Sprifermin (Recombinant Human Fibroblast Growth Factor 18) in Knee Osteoarthritis

    DEFF Research Database (Denmark)

    Lohmander, L. S.; Hellot, S.; Dreher, D.

    2014-01-01

    Objective. To evaluate the efficacy and safety of intraarticular sprifermin (recombinant human fibroblast growth factor 18) in the treatment of symptomatic knee osteoarthritis (OA). Methods. The study was a randomized, double-blind, placebo-controlled, proof-of-concept trial. Intraarticular sprif...

  14. Indications for intra-articular steroid in osteoarthritis of the ankle and ...

    African Journals Online (AJOL)

    The results of treatment with intra-articular steroid in an unselected group of patients with osteo-arthritis of the ankle and metatarsophalangeal joint of the big toe are described. From the results of this trial it is possible to lay down indications for the use of intra-articular steroid in these conditions. In the ankle joint it is ...

  15. Comparison of efficacy of intra-articular morphine and steroid in patients with knee osteoarthritis

    Directory of Open Access Journals (Sweden)

    Serbülent Gökhan Beyaz

    2012-01-01

    Full Text Available Introduction: Primary therapeutic aim in treatment of osteoarthritis of the knee is to relieve the pain of osteoarthritis. The aim of this study was to compare the efficacy of intra-articular triamcinolone with intra-articular morphine in pain relief due to osteoarthritis of the knee in the elderly population. Materials and Methods: Patients between 50 and 80 years of age were randomized into three groups. Group M received morphine plus bupivacaine intra-articularly, Group T received triamcinolone plus bupivacaine intra-articularly, and Group C received saline plus bupivacaine intra-articularly. Patients were evaluated before injection and in 2nd, 4th, 6th, and 12th weeks after injection. First-line supplementary analgesic was oral paracetamol 1500 mg/day. If analgesia was insufficient with paracetamol, oral dexketoprofen trometamol 50 mg/day was recommended to patients. Results: After the intra-articular injection, there was statistically significant decrease in visual analog scale (VAS scores in Groups M and T, when compared to Group C. The decrease of VAS scores seen at the first 2 weeks continued steadily up to the end of 12th week. There was a significant decrease in Groups M and T in the WOMAC scores, when compared to Group C. There was no significant difference in the WOMAC scores between morphine and steroid groups. Significantly less supplementary analgesics was used in the morphine and steroid groups. Conclusion: Intra-articular morphine was as effective as intra-articular triamcinolone for analgesia in patients with osteoarthritis knee. Intra-articular morphine is possibly a better option than intra-articular steroid as it has lesser side effects.

  16. Will a single periarticular lidocaine-corticosteroid injection improve the clinical efficacy of intraarticular hyaluronic acid treatment of symptomatic knee osteoarthritis?

    Science.gov (United States)

    Ertürk, Cemil; Altay, Mehmet Akif; Altay, Nuray; Kalender, Ali Murat; Öztürk, İbrahim Avşin

    2016-11-01

    A local injection of corticosteroid-lidocaine into the periarticular soft tissue structures is used commonly for rapid pain relief. It is hypothesized that knee pain associated with knee osteoarthritis would be relieved quickly and effectively in patients receiving intraarticular hyaluronic acid combined with a periarticular lidocaine-corticosteroid injection. To test this hypothesis, the clinical effect of the combined treatment with hyaluronic acid injection alone in patients with symptomatic knee osteoarthritis as compared in this prospective single-blinded randomized trial. This study included 70 patients. Group 1 (n = 35) received intraarticular hyaluronic acid injections only, whereas group 2 (n = 35) received intraarticular hyaluronic acid injections combined with a single local injection of corticosteroid-lidocaine. Injections were administered to the most painful areas of the anterior or posterior medial condyle of the femur or tibia. The outcome was measured by independent assessors (blinded to treatment) using a linear VAS pain scale and WOMAC and HSS knee scores. Assessments were performed at baseline and at 1, 3, 6, 12, 26, and 52 weeks. During the first 3 weeks, group 2 patients showed significantly better all scores than did group 1 patients (p hyaluronic acid alone in patients with knee osteoarthritis and can be considered a useful adjunctive treatment modality. This combined method may provide early return to patient's daily activity. Therapeutic study, Level I.

  17. Usefulness of intra-articular bupivacain and lidocain adjunction in MR or CT arthrography: A prospective study in 148 patients

    International Nuclear Information System (INIS)

    Mosimann, Pascal J.; Richarme, Delphine; Becce, Fabio; Knoepfli, Anne-Sophie; Mino, Vincent; Meuli, Reto; Theumann, Nicolas

    2012-01-01

    Purpose: To evaluate the influence of shorter- and longer-acting intra-articular anaesthetics on post-arthrographic pain. Materials and methods: 154 consecutive patients investigated by MR or CT arthrographies were randomly assigned to one of the following groups: 1 – intra-articular contrast injection only; 2 – lidocain 1% adjunction; or 3 – bupivacain 0.25% adjunction. Pain was assessed before injection, at 15 min, 4 h, 1 day and 1 week after injection by visual analogue scale (VAS). Results: At 15 min, early mean pain score increased by 0.96, 0.24 and 0 in groups 1, 2 and 3, respectively. Differences between groups 1 and 3 and 1 and 2 were statistically significant (p = 0.003 and 0.03, respectively), but not between groups 2 and 3 (p = 0.54). Delayed mean pain score increase was maximal at 4 h, reaching 1.60, 1.22 and 0.29 in groups 1, 2 and 3, respectively. Differences between groups 1 and 2 and 2 and 3 were statistically significant (p = 0.002 and 0.02, respectively), but not between groups 1 and 2 (p = 0.46). At 24 h and 1 week, the interaction of local anaesthetics with increase in pain score was no longer significant. Results were independent of age, gender and baseline VAS. Conclusion: Intra-articular anaesthesia may significantly reduce post-arthrographic pain. Bupivacain seems to be more effective than lidocain to reduce both early and delayed pain

  18. Influência da anestesia venosa total, entropia e laparoscopia sobre o estresse oxidativo

    Directory of Open Access Journals (Sweden)

    Rogean Rodrigues Nunes

    2012-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Estudos recentes correlacionam mortalidade pós-operatória e anestésica, especialmente a profundidade anestésica e pressão arterial sistólica (PAS. O objetivo deste estudo foi avaliar os efeitos da profundidade da anestesia venosa total (AVT realizada com remifentanil e propofol com monitoração da entropia de resposta (RE sobre as concentrações sanguíneas dos marcadores do estresse oxidativo: TBARS e glutationa, durante operações pelo acesso vídeolaparoscópico. MÉTODO: Vinte pacientes adultas, ASA I, IMC 20-26 kg.m-2, idades entre 20 e 40 anos, foram aleatoriamente distribuidas em dois grupos iguais: Grupo I - submetidas a procedimento anestésico-cirúrgico com RE mantida entre 45 e 59 e Grupo II - submetidas a procedimento anestésico-cirúrgico com RE entre 30 e 44. Em ambos os grupos, a infusão de remifentanil e propofol foi controlada pelo sitio efetor (Se, ajustados para manter RE nos valores desejados (Grupos I e II e avaliando-se sempre a taxa de supressão (TS. As pacientes foram avaliadas em seis momentos: M1(imediatamente antes da indução anestésica, M2 (antes da intubação traqueal [IT], M3 (5 minutos após IT, M4 (imediatamente antes do pneumoperitônio-PPT, M5 (1 minuto após o PPT e M6 (uma hora após a operação. Em todos os momentos foram avaliados os seguintes parâmetros: PAS, PAD, FC, RE, TS, TBARS e glutationa. RESULTADOS: Observaram-se aumentos no TBARS e glutationa em M5, tanto no Grupo I como no Grupo II (p GI em M5 - p < 0,05% sugerem interferência de mais um fator (anestesia profunda, como responsável pelo aumento no MA, provavelmente como resultados de maior depressão do sistema nervoso autônomo e menor autorregulação esplâncnica.

  19. Epidermólisis bulosa en el niño y anestesia

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    Joaquín L. de la Lastra Rodríguez

    1999-06-01

    Full Text Available La epidermólisis bulosa comprende un grupo heterogéneo de enfermedades ampollosas de la piel y mucosas de origen congénito y hereditario. El tratamiento es insatisfactorio en gran parte, por lo cual son necesarias ciertas medidas para proteger al paciente y evitar la aparición de dichas lesiones y sus complicaciones. Se describe el manejo anestesiológico en un niño de 3 años de edad, al que se le administró anestesia general intravenosa con clorhidrato de ketamina y diazepán, y se describen todos los cuidados y recomendaciones que hay que tener para evitar especialmente los roces, las presiones y las temperaturas altas.Epidermolysis bullosa is a heterogenous group of ampullary diseases of the skin and mucosas of congenital and hereditary origin. The treatment is largely unsatisfactory, and that´s why it is necessary to take some measures to protect the patient and to prevent the appareance of such lesions and their complications. It is described the anesthetic management of a 3-year-old child that was administered intravenous general anesthesia with ketamine hydrochlorate and diazepam. The care and recommendations that should be taken into account to avoid touches, pressures and high temperatures, are described.

  20. Avaliação da memória sob anestesia venosa total Evaluación de la memoria bajo anestesia venosa total The assessment of memory under total intravenous anesthesia

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    Gulistan Aktas

    2013-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Neste estudo, objetivamos avaliar a memória implícita e explícita em pacientes submetidos à cirurgia abdominal sob anestesia venosa total (AVT com propofol e remifentanil, na qual o nível de anestesia foi controlado pelo monitoramento do índice bispectral (BIS. MÉTODO: Anestesia venosa total foi administrada a 60 pacientes adultos para obter níveis de BIS de 40-60. Os pacientes foram randomicamente divididos em três grupos, de acordo com as gravações que ouviram. Os pacientes do grupo categoria (CT ouviram uma fita gravada contendo cinco nomes de animais. Os pacientes do grupo recordar palavras (RP ouviram uma fita gravada contendo cinco palavras de frequência média na língua turca, depois de adaptadas. Os pacientes do grupo controle (GC ouviram os sons do mar até o fim da cirurgia. Duas horas após a cirurgia, os testes foram administrados a cada paciente na sala de recuperação para avaliar a memória. RESULTADOS: Houve uma diferença entre os escores dos grupos CT e GC no Miniexame do Estado Mental (MMSE; todos os escores foram > 20. Os resultados dos testes de categoria e recordar palavras, aplicados para avaliar a memória implícita, não foram estatisticamente diferentes entre os grupos. Não houve evidência de memória implícita em nenhum dos pacientes. Um paciente lembrou-se de ouvir "o som de água" como uma prova de memória explícita. Onze pacientes declararam não ter sonhado. CONCLUSÕES: Apesar de não termos encontrado nenhuma evidência de memória implícita sob anestesia adequada com AVT, um paciente apresentou memória explícita. Embora a profundidade adequada da anestesia fornecida pelo monitoramento do BIS corrobore nossos resultados para a memória implícita, ela não explica os resultados para a memória explícita.JUSTIFICATIVA Y OBJETIVOS: En este estudio evaluamos la memoria implícita y explícita en pacientes sometidos a la cirugía abdominal bajo anestesia venosa total

  1. Combined intra-articular glucocorticoid, bupivacaine and morphine reduces pain and convalescence after diagnostic knee arthroscopy

    DEFF Research Database (Denmark)

    Rasmussen, Sten; Lorentzen, Jan S; Larsen, Allan S

    2002-01-01

    We studied the effect of intra-articullar saline vs. bupivacaine + morphine or bupivacaine morphine + methylprednisolone after diagnostic knee arthroscopy. In a double-blind randomized study, 60 patients undergoing diagnostic knee arthroscopy without a therapeutic procedure were allocated to groups...... receiving intra-articular saline, intra-articular bupivacaine 150 mg + morphine 4 mg or the same dose of bupivacaine + morphine + intra-articular methylprednisolone 40 mg at the end of arthroscopy during general anesthesia. All patients were instructed to resume normal activities immediately after...

  2. Intraarticular and intravenous administration of 99MTc-HMPAO-labeled human mesenchymal stem cells (99MTC-AH-MSCS): In vivo imaging and biodistribution

    International Nuclear Information System (INIS)

    Meseguer-Olmo, Luis; Montellano, Antonio Jesús; Martínez, Teresa; Martínez, Carlos M.; Revilla-Nuin, Beatriz; Roldán, Marta; Mora, Cristina Fuente; López-Lucas, Maria Dolores; Fuente, Teodomiro

    2017-01-01

    Introduction: Therapeutic application of intravenous administered (IV) human bone marrow-derived mesenchymal stem cells (ahMSCs) appears to have as main drawback the massive retention of cells in the lung parenchyma, questioning the suitability of this via of administration. Intraarticular administration (IAR) could be considered as an alternative route for therapy in degenerative and traumatic joint lesions. Our work is outlined as a comparative study of biodistribution of 99m Tc-ahMSCs after IV and IAR administration, via scintigraphic study in an animal model. Methods: Isolated primary culture of adult human mesenchymal stem cells was labeled with 99m Tc-HMPAO for scintigraphic study of in vivo distribution after intravenous and intra-articular (knee) administration in rabbits. Results: IV administration of radiolabeled ahMSCs showed the bulk of radioactivity in the lung parenchyma while IAR images showed activity mainly in the injected cavity and complete absence of uptake in pulmonary bed. Conclusions: Our study shows that IAR administration overcomes the limitations of IV injection, in particular, those related to cells destruction in the lung parenchyma. After IAR administration, cells remain within the joint cavity, as expected given its size and adhesion properties. Advances in knowledge: Intra-articular administration of adult human mesenchymal stem cells could be a suitable route for therapeutic effect in joint lesions. Implications for patient care: Local administration of adult human mesenchymal stem cells could improve their therapeutic effects, minimizing side effects in patients.

  3. Anestesia em paciente com síndrome de Gilbert: relato de caso Anestesia en paciente con síndrome de Gilbert: relato de caso Anesthesia in a patient with Gilbert's syndrome: case report

    Directory of Open Access Journals (Sweden)

    Fabiano Timbó Barbosa

    2004-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A síndrome de Gilbert é uma doença crônica benigna, a qual leva à icterícia recorrente com grande aumento da bilirrubina não conjugada, que pode levar à toxicidade após o uso de medicações utilizadas na prática diária. O objetivo deste relato é descrever a conduta anestésica em uma paciente com síndrome de Gilbert, submetida à cirurgia videolaparoscópica. RELATO DO CASO: Paciente do sexo feminino, com 22 anos, portadora da síndrome de Gilbert, submetida à cirurgia videolaparoscópica sob anestesia geral com propofol, alfentanil, succinilcolina, atracúrio e isoflurano. Não houve sinais de toxicidade durante a anestesia. A paciente apresentou recuperação pós-operatória sem intercorrências e recebeu alta hospitalar após três dias. CONCLUSÕES: O paciente portador da síndrome de Gilbert pode ser submetido à anestesia geral de forma segura sem o aparecimento de toxicidade desde que sejam evitados os fatores que possam levar à diminuição da atividade da glicuroniltransferase.JUSTIFICATIVA Y OBJETIVOS: La síndrome de Gilbert es una enfermedad crónica benigna la cual lleva a la ictericia recurrente con grande aumento de la bilirrubina no conjugada, que puede llevar a la toxicidad después del uso de medicamentos utilizadas en la práctica diaria. El objetivo de este relato es describir la conducta anestésica en una paciente con síndrome de Gilbert, sometida a cirugía videolaparoscópica. RELATO DEL CASO: Paciente del sexo femenino, con 22 años, portadora de la síndrome de Gilbert fue sometida a cirugía videolaparoscópica bajo anestesia general con propofol, alfentanil, succinilcolina, atracúrio e isoflurano. No hubo señales de toxicidad durante la anestesia. La paciente presentó recuperación pós-operatoria sin intercurrencias y recibió alta hospitalar después de tres días. CONCLUSIONES: El paciente portador del síndrome de Gilbert puede ser sometido a la anestesia general de

  4. Assessing adverse effects of intra-articular botulinum toxin A in healthy Beagle dogs: A placebo-controlled, blinded, randomized trial.

    Science.gov (United States)

    Heikkilä, Helka M; Jokinen, Tarja S; Syrjä, Pernilla; Junnila, Jouni; Hielm-Björkman, Anna; Laitinen-Vapaavuori, Outi

    2018-01-01

    To investigate the clinical, cytological, and histopathological adverse effects of intra-articularly injected botulinum toxin A in dogs and to study whether the toxin spreads from the joint after the injection. A longitudinal, placebo-controlled, randomized clinical trial was conducted with six healthy laboratory Beagle dogs. Stifle joints were randomized to receive either 30 IU of onabotulinum toxin A or placebo in a 1:1 ratio. Adverse effects and spread of the toxin were examined by evaluating dynamic and static weight-bearing of the injected limbs, by assessing painless range of motion and pain on palpation of joints, and by performing synovial fluid analysis, neurological examination, and electrophysiological recordings at different examination time-points in a 12-week period after the injections. The dogs were then euthanized and autopsy and histopathological examination of joint structures and adjacent muscles and nerves were performed. Intra-articular botulinum toxin A did not cause local weakness or injection site pain. Instead, static weight-bearing and painless range of motion of stifle joints decreased in the placebo limbs. No clinically significant abnormalities associated with intra-articular botulinum toxin A were detected in the neurological examinations. Electrophysiological recordings showed low compound muscle action potentials in two dogs in the botulinum toxin A-injected limb. No significant changes were detected in the synovial fluid. Autopsy and histopathological examination of the joint and adjacent muscles and nerves did not reveal histopathological adverse effects of the toxin. Intra-articular botulinum toxin A does not produce significant clinical, cytological, or histopathological adverse effects in healthy dogs. Based on the electrophysiological recordings, the toxin may spread from the joint, but its clinical impact seems to be low.

  5. Anestesia em paciente com Xeroderma Pigmentoso: relato de caso Anestesia en paciente con Xeroderma Pigmentoso: relato de caso Anesthesia in patient with Xeroderma Pigmentosum: case report

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    Carlos Rogério Degrandi Oliveira

    2003-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O Xeroderma Pigmentoso é uma doença autossômica recessiva rara, caracterizada pelo desenvolvimento prematuro de neoplasias devido à extrema sensibilidade à radiação ultravioleta. Estas manifestações ocorrem por falha no mecanismo de excisão e reparo do DNA. Se comparados a indivíduos normais, estes pacientes apresentam risco 1000 vezes maior de desenvolver neoplasias em áreas expostas ao sol. O objetivo deste relato é apresentar a conduta anestésica em uma paciente portadora de Xeroderma Pigmentoso submetida à cirurgia oftalmológica. RELATO DO CASO: Paciente do sexo feminino, 7 anos, portadora de Xeroderma Pigmentoso com comprometimento facial extenso, admitida para exérese de lesão papilar no olho direito. Foi prescrito midazolam (10 mg por via oral, como medicação pré-anestésica. A monitorização inicial consistiu de cardioscópio, oxímetro de pulso, estetoscópio precordial e pressão arterial não invasiva. Foi realizada pré-oxigenação com oxigênio a 100% por 3 minutos e indução inalatória sob máscara com oxigênio a 100% e sevoflurano em concentrações crescentes até 7%. Após acesso venoso periférico com cateter 22G, foram injetados propofol (50 mg e succinilcolina (20 mg e realizada intubação traqueal com tubo 5,5 mm sem balonete. Um guia de metal foi utilizado para facilitar a introdução do tubo traqueal. A manutenção da anestesia foi feita com sevoflurano a 3,5% e oxigênio a 100%, com sistema de Bain. A criança foi extubada na sala cirúrgica e encaminhada à sala de recuperação pós-anestésica em boas condições. CONCLUSÕES: As alterações faciais e orofaríngeas decorrentes desta doença determinaram dificuldades na adaptação da máscara facial e intubação traqueal. A educação constante do paciente e de seus familiares constitui o objetivo mais importante no manuseio desta doença.JUSTIFICATIVA Y OBJETIVOS: El Xeroderma Pigmentoso es una enfermedad autos

  6. An evaluation of new circle system of anesthesia. Quantitative anesthesia with isoflurane in new zealand rabbits Avaliação de um novo sistema circular de anestesia: anestesia quantitativa com isuflorane em coelhos

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    Neuber M. Fonseca

    1997-12-01

    Full Text Available A small circuit system of anesthesia was developed by Fonseca and Goldenberg in 1993. The authors used in this study New Zealand White (NZW rabbits under closed system anesthetic regiment by insoflurane. Twenty male adult New Zealand rabbits were distributed in two groups of ten animals. No premedicant drugs were given. Endotraqueal intubation was made after intravenous administration of propofol (10mg/kg. Insoflurane was used to anesthesia management, administred by lowflow closed system technique with cooper kettle vaporizer, fixed by pre-calculated vaporizing flow in double times intervals. The group II underwent surgical periostal scratching in the medial tibial surface at the proximal shaft. Rabbits breathed spontaneously. Hypotensio, hypercapnia and respiratory acidosis were characteristic of the cardiopulmonary effects of the anesthesia. The corneal reflex and pinch reflex was useful as reliable indicators of anesthesic depth. Manual or mechanical ventilation should be considered as a way of improving alveolar ventilation and normalize blood-gas values. The system developed by Fonseca and Goldenberg was considered suitable for anesthesic management in rabbits.Um sistema circular de anestesia para animais de pequeno porte foi desenvolvido por FONSECA e GOLDENBERG, em 1993. No presente estudo foram utilizados 20 coelhos brancos linhagem Nova Zelândia, submetidos ao sistema com isoflurane, distribuidos em dois grupos de 10 animais. O grupo I, controle, que foi apenas anestesiado e o grupo II foi submetido a raspagem periostal da parte proximal e medial da tíbia. Não foi administrada droga pré-anestésica. Após administração do propofol intravenoso (10mg/kg procedeu-se a intubação endotraqueal. O isuflorane foi administrado lentamente no sistema circular de anestesia. Os animais respiravam espontaneamente. Houve efeitos cardiorespiratórios conseqüentes da anestesia, tais como, hipotensão, hipercapnia e acidose respiratória. O

  7. local

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    Abílio Amiguinho

    2005-01-01

    Full Text Available The process of socio-educational territorialisation in rural contexts is the topic of this text. The theme corresponds to a challenge to address it having as main axis of discussion either the problem of social exclusion or that of local development. The reasons to locate the discussion in this last field of analysis are discussed in the first part of the text. Theoretical and political reasons are there articulated because the question is about projects whose intentions and practices call for the political both in the theoretical debate and in the choices that anticipate intervention. From research conducted for several years, I use contributions that aim at discuss and enlighten how school can be a potential locus of local development. Its identification and recognition as local institution (either because of those that work and live in it or because of those that act in the surrounding context are crucial steps to progressively constitute school as a partner for development. The promotion of the local values and roots, the reconstruction of socio-personal and local identities, the production of sociabilities and the equation and solution of shared problems were the dimensions of a socio-educative intervention, markedly globalising. This scenario, as it is argued, was also, intentionally, one of transformation and of deliberate change of school and of the administration of the educative territoires.

  8. Skin Necrosis from Intra-articular Hyaluronic Acid Injection.

    Science.gov (United States)

    Kim, Whan B; Alhusayen, Raed O

    2015-01-01

    Tissue necrosis is a rare yet potentially serious complication of intra-articular (IA) hyaluronic acid (HA) injections for treatment of knee osteoarthritis. To report a case of a patient with cutaneous necrosis after IA HA injection for treatment of knee osteoarthritis, presenting as a livedoid violaceous patch on the right knee. We report a case of cutaneous necrosis as a rare complication of IA HA injection for treatment of knee osteoarthritis. A literature review was undertaken of similar cases. Use of HA IA injections in the treatment of osteoarthritis can result in similar skin necrosis at uncommon anatomic locations corresponding to the site of HA injection. Although tissue necrosis is a rare complication, physicians need to be aware of this possibility as a complication of HA IA injections in the treatment of osteoarthritis and should be mindful of potential treatment options to manage this adverse event. © 2014 Canadian Dermatology Association.

  9. Intra-Articular Polyacrylamide Hydrogel Injections Are Not Innocent

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    Murat Tonbul

    2014-01-01

    Full Text Available Osteoarthritis is a chronic disorder characterized by joint cartilage degeneration with concomitant changes in the synovium and subchondral bone metabolism. Many conservative treatment modalities, one of which is intra-articular injections, have been described for the treatment of this disorder. Traditionally, hyaluranic acid and corticosteroids are the agents that have been used for this purpose. Recently, polyacrylamide hydrogels are being used widely. Biocompatibility, nonbioabsorbability, and anti-infectious effect obtained by silver addition made polyacrylamide hydrogels more popular. In this paper, we present a case and the method of our management, in whom host tissue reaction (foreign body granuloma, edema, inflammation, and redness induration has been observed, as the first and unique adverse effect reported in the literature.

  10. Intra-Articular Viscosupplementation With Hylan G-F 20 To Treat Osteoarthritis of the Knee

    Science.gov (United States)

    2005-01-01

    , but were not limited to, the characteristics of the patients, method of randomization, type of control intervention, outcome measures for effectiveness and safety, and length of follow-up. The quality of the studies and level of the evidence was initially scored by one clinical epidemiologist using the Jadad scale and GRADE approach. Level of quality depends on the amount of certainty about the magnitude of effect and is based on study designs, extent of methodological limitations, consistency of results and applicability (i.e. directness) to the Ontario clinical context. The GRADE approach also permits comment on the strength of recommendations resulting from the evidence, based on estimates of the magnitude of effect relative to the magnitude of risk and burden and the level of certainty around these estimates. The quality assessments were subsequently peer-reviewed. Summary of Findings The literature search revealed 2 previous health technology assessments, 3 meta-analyses of placebo-controlled trials, 1 Cochrane review and meta-analysis encompassing 18 randomized controlled trials (RCTs) that compared hylan G-F 20 to either placebo or active treatments, 11 RCTs of hylan G-F 20 (all included in the Cochrane review), and 10 observational studies. Given the preponderance of evidence, the Medical Advisory Secretariat’s analysis focused on studies with Level 1 evidence of effectiveness (i.e., the meta-analyses of RCTs and the RCTs). Only safety data from the observational studies were included. The authors of the 2 health technology assessments concluded that the data were sparse and poor quality. There was some evidence that hylan G-F 20 delivered a small, clinical benefit at 3 to 6 months after treatment on a magnitude comparable to NSAIDs and intra-articular steroids. Hylan G-F 20 appeared to carry a risk of a local adverse reaction of in the range of 3% to 18% per 100 injections, but there was no apparent risk of a severe adverse event, although the data were

  11. Anestesia regional para cirugía cardiovascular pediátrica

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    Lincoln de la Parte Pérez

    2004-03-01

    Full Text Available Durante los últimos años se han publicado numerosos artículos sobre el uso de anestesia espinal y peridural asociada a la anestesia general, en niños sometidos a operaciones cardiovasculares. El uso de esta técnica produce una disminución significativa de la respuesta de estrés que se observa durante y después de las operaciones cardiovasculares y que es particularmente intensa en recién nacidos y lactantes. Adicionalmente produce una mejor función pulmonar, mayor estabilidad hemodinámica, posibilidad de extubación precoz, excelente analgesia posoperatoria y una menor estadía en la sala de recuperación anestésica. Las complicaciones más importantes asociadas a su uso son la hipotensión arterial, la depresión respiratoria y el hematoma epidural. Las contraindicaciones más importantes para la realización de estas técnicas incluyen la presencia de cianosis, policitemia, coagulopatía preexistente y en los lactantes menores de 6 meses. Existe además un dilema ético importante relacionado con su uso. Por una parte es cierto que pueden obtenerse un grupo de ventajas, que también podrían lograrse con la aplicación de otras técnicas encaminadas a la extubación precoz (Fast track cardiac anesthesia y por la otra, existe siempre el peligro latente de sangramiento y de formación de un hematoma epidural. Se realiza una revisión bibliográfica sobre las diferentes técnicas utilizadas.Several articles have been published on the use of spinal and epidural anesthesia associated with general anesthesia in children undergoing cardiovascular surgery. The use of this technique causes a significant decrease of the stress response observed during and after cardiovascular surgery and that is particularly intense in newborns and infants. Besides, it produces a better pulmonary function, a longer hemodynamic stability, the possibility of fast track cardiac anesthesia, an excellent postoperative analgesia and a shorter stay in the

  12. Accuracy of magnetic resonance in identifying traumatic intraarticular knee lesions

    International Nuclear Information System (INIS)

    Vaz, Carlos Eduardo Sanches; Camargo, Olavo Pires de; Santana, Paulo Jose de; Valezi, Antonio Carlos

    2005-01-01

    Purpose: To evaluate the diagnostic accuracy of magnetic resonance imaging of the knee in identifying traumatic intraarticular knee lesions. Method: 300 patients with a clinical diagnosis of traumatic intraarticular knee lesions underwent prearthoscopic magnetic resonance imaging. The sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio for a positive test, likelihood ratio for a negative test, and accuracy of magnetic resonance imaging were calculated relative to the findings during arthroscopy in the studied structures of the knee (medial meniscus, lateral meniscus, anterior cruciate ligament, posterior cruciate ligament, and articular cartilage). Results: Magnetic resonance imaging produced the following results regarding detection of lesions: medial meniscus: sensitivity 97.5%, specificity 92.9%, positive predictive value 93.9%, positive negative value 97%, likelihood positive ratio 13.7, likelihood negative ratio 0.02, and accuracy 95.3%; lateral meniscus: sensitivity 91.9%, specificity 93.6%, positive predictive value 92.7%, positive negative value 92.9%, likelihood positive ratio 14.3, likelihood negative ratio 0.08, and accuracy 93.6%; anterior cruciate ligament: sensitivity 99.0%, specificity 95.9%, positive predictive value 91.9%, positive negative value 99.5%, likelihood positive ratio 21.5, likelihood negative ratio 0.01, and accuracy 96.6%; posterior cruciate ligament: sensitivity 100%, specificity 99%, positive predictive value 80.0%, positive negative value 100%, likelihood positive ratio 100, likelihood negative ratio 0.01, and accuracy 99.6%; articular cartilage: sensitivity 76.1%, specificity 94.9%, positive predictive value 94.7%, positive negative value 76.9%, likelihood positive ratio 14.9, likelihood negative ratio 0.25, and accuracy 84.6%. Conclusion: Magnetic resonance imaging is a satisfactory diagnostic tool for evaluating meniscal and ligamentous lesions of the knee, but it is unable to clearly

  13. Accuracy of magnetic resonance in identifying traumatic intraarticular knee lesions

    Directory of Open Access Journals (Sweden)

    Vaz Carlos Eduardo Sanches

    2005-01-01

    Full Text Available PURPOSE: To evaluate the diagnostic accuracy of magnetic resonance imaging of the knee in identifying traumatic intraarticular knee lesions. METHOD: 300 patients with a clinical diagnosis of traumatic intraarticular knee lesions underwent prearthoscopic magnetic resonance imaging. The sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio for a positive test, likelihood ratio for a negative test, and accuracy of magnetic resonance imaging were calculated relative to the findings during arthroscopy in the studied structures of the knee (medial meniscus, lateral meniscus, anterior cruciate ligament, posterior cruciate ligament, and articular cartilage. RESULTS: Magnetic resonance imaging produced the following results regarding detection of lesions: medial meniscus: sensitivity 97.5%, specificity 92.9%, positive predictive value 93.9%, positive negative value 97%, likelihood positive ratio 13.7, likelihood negative ratio 0.02, and accuracy 95.3%; lateral meniscus: sensitivity 91.9%, specificity 93.6%, positive predictive value 92.7%, positive negative value 92.9%, likelihood positive ratio 14.3, likelihood negative ratio 0.08, and accuracy 93.6%; anterior cruciate ligament: sensitivity 99.0%, specificity 95.9%, positive predictive value 91.9%, positive negative value 99.5%, likelihood positive ratio 21.5, likelihood negative ratio 0.01, and accuracy 96.6%; posterior cruciate ligament: sensitivity 100%, specificity 99%, positive predictive value 80.0%, positive negative value 100%, likelihood positive ratio 100, likelihood negative ratio 0.01, and accuracy 99.6%; articular cartilage: sensitivity 76.1%, specificity 94.9%, positive predictive value 94.7%, positive negative value 76.9%, likelihood positive ratio 14.9, likelihood negative ratio 0.25, and accuracy 84.6%. CONCLUSION: Magnetic resonance imaging is a satisfactory diagnostic tool for evaluating meniscal and ligamentous lesions of the knee, but it is

  14. Anestesia subtenoniana en cirugía de estrabismo Sub-Tenon's anesthesia in strabismus surgery

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    Rosa M. Naranjo Fernández

    2004-12-01

    Full Text Available Se realizó un estudio descriptivo, retrospectivo de 30 pacientes con el diagnóstico de estrabismo que acudieron al Servicio de Oftalmología Pediátrica y Estrabismo del Hospital Oftalmológico Docente "Ramón Pando Ferrer" y fueron operados con la técnica de anestesia subtenoniana desde abril de 2003 hasta mayo de 2004; se analizaron las variables: edad, entidad diagnostica y grado de dolor. Se encontró que el rango de edad que predominó fue de 20 a 39 años, la esotropía como el diagnóstico más frecuente, el grado de dolor fue significativo en la tracción muscular y la técnica anestésica subtenoniana resultó efectiva independientemente de la técnica quirúrgica aplicada, sin complicaciones y con buena analgesia.A descriptive and retrospective study of 30 patients with the diagnosis of strabismus that were operated on at the Service of Pediatric Ophthalmology and Strabismus of "Ramón Pando Ferrer" Ophthalmological Hospital by the technique of sub-Tenon's anesthesia from April 2003 to May 2004 was conducted.The following variables were analyzed: age, diagnostic entity and pain degree. It was found a predominance of the age range 20-39. Esotropia was the most frequent diagnosis. The pain degree was significant in the muscular traction and the sub-Tenon's anesthetic technique proved to be effective independently of the surgical technique applied, without complications and with good analgesia.

  15. ANESTESIA EM EQÜINOS COM DETOMIDINA E TILETAMINA-ZOLAZEPAM

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    Cláudio Corrêa Natalini

    1994-01-01

    Full Text Available RESUMO Seis eqüinos foram anestesiados, via intravenosa, com o cloridrato de detomidina 1% (0,03mg/kg, associado à combinação tiletamina-zolazepam 5% (1mg/kg. Foram registrados o tempo para obtenção do decúbito lateral e o tempo para retorno à posição de estação. As freqüências cardíaca e respiratória, a temperatura retal, os vaiores arteriais de pH, PCO2, PO2, HCO3, excesso de bases e SATO2, foram analisados no período anterior à sedação (valor basal, durante a anestesia e ao retorno à posição de estação. Dois eqüinos foram submetidos a procedimentos cirúrgicos. O tempo médio para a obtenção do decúbito lateral foi de 53,80 ± 9,06 segundos. O período médio em decúbito lateral foi de 28,50 ± 5,05 minutos e o tempo para retorno à estação foi de 39,16 ± 4,59 minutos. A análise hemogasométrica arterial revelou a ocorrência de hipoxemia no período anestésico. As freqüências cardíaca, respiratória e temperatura retal mantiveram-se estáveis no período estudado.

  16. Analgesia de parto: estudo comparativo entre anestesia combinada raquiperidural versus anestesia peridural contínua Analgesia de parto: estudio comparativo entre anestesia combinada raqui-peridural versus anestesia peridural continua Labor analgesia: a comparative study between combined spinal-epidural anesthesia versus continuous epidural anesthesia

    Directory of Open Access Journals (Sweden)

    Carlos Alberto de Figueiredo Côrtes

    2007-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O alívio da dor no trabalho de parto tem recebido atenção constante visando ao bem-estar materno, diminuindo o estresse causado pela dor e reduzindo as conseqüências deste sobre o concepto. Inúmeras técnicas podem ser utilizadas para analgesia de parto. Este trabalho teve como objetivo comparar a técnica peridural contínua com a combinada, ambas com o uso de bupivacaína a 0,25% em excesso enantiomérico 50% e fentanil como agentes. MÉTODO: Participaram do estudo 40 parturientes em trabalho de parto com dilatação cervical entre 4 e 5 cm que foram distribuídas em dois grupos iguais de forma aleatória. O Grupo I recebeu anestesia peridural contínua. O Grupo II recebeu anestesia combinada. Foram avaliados: medidas antropométricas, idade gestacional, dilatação cervical, tempo entre o bloqueio e a ausência de dor por meio da escala analógica visual, possibilidade de deambulação, tempo entre o início da analgesia e a dilatação cervical completa, duração do período expulsivo, parâmetros hemodinâmicos maternos e vitalidade do recém-nascido. Possíveis complicações, como depressão respiratória, hipotensão arterial materna, prurido, náuseas e vômitos, também foram observadas. Para a comparação das médias utilizou-se o teste t de Student e para a paridade e tipo de parto utilizou-se o teste do Qui-quadrado. RESULTADOS: Não houve diferença estatística significativa entre os dois grupos em relação ao tempo entre o início da analgesia e a dilatação cervical completa, bem como em relação ao tempo da duração do período expulsivo, incidência de cesariana relacionada com a analgesia, parâmetros hemodinâmicos maternos e vitalidade do recém-nascido. CONCLUSÕES: Ambas as técnicas se mostraram eficazes e seguras para a analgesia do trabalho de parto, embora a técnica combinada tenha proporcionado um rápido e imediato alívio da dor. Estudos clínicos com maior número de casos s

  17. Doença de Moyamoya e anestesia com sevoflurano fora do centro cirúrgico: relato de caso

    OpenAIRE

    Machado, Sheila Braga; Mendes, Florentino Fernandes; Angelini, Adriana de Campos

    2002-01-01

    JUSTIFICATIVA E OBJETIVOS: A doença de Moyamoya é uma desordem cerebrovascular progressiva que representa um desafio anestésico em virtude da precária circulação cerebral destes pacientes, constituindo-se numa importante causa de acidente vascular cerebral em indivíduos jovens. O objetivo deste relato é apresentar o caso de um paciente com doença de Moyamoya que foi submetido à anestesia geral com sevoflurano para procedimento diagnóstico fora do centro cirúrgico. RELATO DO CASO: Criança com ...

  18. Anestesia venosa total (AVT) em lactente com doença de Werdnig-Hoffmann: relato de caso

    OpenAIRE

    Resende, Marco Antonio Cardoso de; Silva, Elizabeth Vaz da; Nascimento, Osvaldo José Moreira; Gemal, Alberto Esteves; Quintanilha, Giseli; Vasconcelos, Eliana Maria

    2010-01-01

    JUSTIFICATIVA E OBJETIVOS: A doença de Werdnig-Hoffmann é a causa mais comum de hipotonia no lactente e quando presente logo após o nascimento tem pior prognóstico. Fraqueza muscular simétrica, arreflexia e fasciculações da língua são característicos. A maioria dos lactentes morre antes dos dois anos por insuficiência respiratória. O presente relato apresenta um caso com técnica venosa total durante anestesia. RELATO DO CASO: Paciente feminina, branca, um ano, 10 kg, estado físico ASA III, co...

  19. Caso: Infección cutánea en el punto de punción de anestesia subaracnoidea

    OpenAIRE

    López Pérez, Jesús; Castañer Ramón-Llín, Carla; Furones Tormo, Beatriz; Fernández Fernández, María Adoración; García Ferreira, Joaquín; Fayos de la Asunción, Miguel E

    2012-01-01

    Mujer de 76 años de edad, con antecedentes de asma bronquial en tratamiento con bromuro de ipatropio e hipertiroidismo tratado con carbimazol. Artrosis generalizada y gonartrosis bilateral. Propuesta para cirugía traumatológica de protesis total de rodilla derecha. Se realiza técnica locorregional mediante anestesia subaracnoidea resultando exitosa tras 4 intentos fallidos de punción, confirmando salida de LCR transparente. Se administra bupivacaina isobárica 14 mg. más 20 mcg de fentanilo...

  20. Intra-articular ganglion cysts of the knee: clinical and MR imaging features

    International Nuclear Information System (INIS)

    Kim, M.G.; Cho, W.H.; Kim, B.H.; Choi, J.A.; Lee, N.J.; Chung, K.B.; Choi, Y.S.; Cho, S.B.; Lim, H.C.

    2001-01-01

    The purpose of this study was to present clinical and MR imaging features of intra-articular ganglion cysts of the knee. Retrospective review of 1685 consecutive medical records and MR examinations of the knee performed at three imaging centers allowed identification of 20 patients (13 men and 7 women; mean age 35 years), in whom evidence of intra-articular ganglion cyst was seen. Of the 20 ganglion cysts, 5 were found in the infrapatellar fat pad, 10 arose from the posterior cruciate ligament, and 5 from the anterior cruciate ligament. Three of five patients with ganglion cyst in the infrapatellar fat pad had a palpable mass. In 7 of 15 patients with ganglion cyst in the intercondylar notch, exacerbation of pain occurred in a squatting position. On four MR arthrographies, ganglion cysts were an intra-articular round, lobulated, low signal intensity lesion. Five cases of fat-suppressed contrast-enhanced T1-weighted SE images demonstrated peripheral thin rim enhancement. The clinical presentation of intra-articular ganglion cyst is varied according to its intra-articular location. The MR appearance of intra-articular ganglion cyst is characteristic and usually associated with the cruciate ligament or the infrapatellar fat pad. Magnetic resonance arthrography has no definite advantage over conventional MR in the evaluation of the lesion. For intra-articular ganglion cyst in the infrapatellar fat pad, fat-suppressed contrast-enhanced MR imaging could be useful, because a thin, rim-enhancing feature of intra-articular ganglion cyst allows it to be distinguished from synovial hemangioma and synovial sarcoma. (orig.)

  1. Diagnosis and management of an intra-articular foreign body in the foot.

    LENUS (Irish Health Repository)

    Mulhall, K J

    2002-10-01

    We describe a case of a small intra-articular foreign body in the foot presenting 48 hours following injury, which at operation showed early evidence of septic arthritis. It is essential to accurately localise periarticular foreign bodies in the foot and proceed to arthrotomy and debridement in all cases where there is radiological or clinical evidence to suggest intra-articular retention of a foreign body.

  2. Editorial Commentary: Intra-articular Corticosteroid Injection at the Time of Knee Arthroscopy Is Not Recommended.

    Science.gov (United States)

    Hunt, Timothy J

    2016-01-01

    In a population of Medicare patients undergoing knee arthroscopy, a significant increase in the incidence of postoperative infection at 3 and 6 months was found in patients who received an intra-articular corticosteroid injection at the time of knee arthroscopy compared with a matched control group that did not receive an injection. Intra-articular corticosteroid injection at the time of knee arthroscopy is not recommended. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  3. Intraarticular cortisone injection for osteoarthritis of the hip. Is it effective? Is it safe?

    OpenAIRE

    Kruse, David W.

    2008-01-01

    Osteoarthritis of the hip is a significant source of morbidity in the elderly. Treatment guidelines are available for the management of hip osteoarthritis, but these do not address the application of intraarticular corticosteroid injection. The intraarticular injection of corticosteroid is used in the management of other large joint osteoarthritic diseases and is well studied in the knee, however, this data cannot be used to make sound clinical decisions regarding its use for hip osteoarthrit...

  4. Exercise increases interleukin-10 levels both intraarticularly and peri-synovially in patients with knee osteoarthritis

    DEFF Research Database (Denmark)

    Helmark, Ida C; Mikkelsen, Ulla R; Børglum, Jens

    2010-01-01

    The microdialysis method was applied to the human knee joint with osteoarthritis (OA) in order to reveal changes in biochemical markers of cartilage and inflammation, intraarticularly and in the synovium, in response to a single bout of mechanical joint loading.......The microdialysis method was applied to the human knee joint with osteoarthritis (OA) in order to reveal changes in biochemical markers of cartilage and inflammation, intraarticularly and in the synovium, in response to a single bout of mechanical joint loading....

  5. Anestesia venosa total para laringectomia parcial em paciente na 28ª semana de gestação: relato de caso

    OpenAIRE

    Costa, José; Mendes, Dalva Maria Carvalho; Lobo, José Eduardo de Oliveira; Furuguem, Adriana Barrozo Ribeiro; Santos, Gabriel Gilberto

    2005-01-01

    JUSTIFICATIVA E OBJETIVOS: Uma anestesia para paciente gestante constitui um desafio ao anestesiologista em virtude dos riscos para a mãe e para o feto. São muitas as complicações descritas pela literatura como malformações fetais, parto prematuro, instabilidade hemodinâmica materna e até morte fetal. O objetivo deste caso é mostrar uma paciente gestante de 28 semanas, submetida a laringectomia parcial sob anestesia geral venosa total com propofol, remifentanil e cisatracúrio. RELATO DO CASO:...

  6. Feasibility of ultrasound-guided intraarticular contrast injection for MR arthrography

    International Nuclear Information System (INIS)

    Baek, Soo Jin; Lee, Jong Min; Kang, Duck Sick

    2005-01-01

    To assess the feasibility of ultrasound-guided intraarticular contrast injection using the posterior approach for MR arthrography. Between June 2002 and October 2004, 132 patients (29 female, 103 male: mean age, 33.6 years) underwent ultrasound-guided intraarticular contrast media injection (40 ml saline + 10 ml 2% lidocaine + 0.2 ml gadopentetate dimeglumine + 0.4 ml epinephrine) for MR arthrography. The patients were classified into four groups, viz. the no leakage group, the minor leakage with successful intraarticular injection group, the major leakage with unsuccessful intraarticular injection group, and the injection failure group. The 'no leakage' and 'minor leakage' groups were considered to be technical successes, while the 'major leakage' and 'injection failure' groups were regarded as technical failures. The technical success rate of ultrasound-guided intraarticular contrast injection using the posterior approach for MR Arthrography was 99.2% (131/132 patients) and one patients 0.7% (1/132 patients) was included in the 'major leakage' group. Ultrasound-guided intraarticular contrast injection using the posterior approach for MR arthrography was feasible with a high success rate

  7. Anestesia ambulatorial para radioterapia em paciente portador de miastenia gravis: relato de caso Anestesia ambulatorial para radioterapia en paciente portador de miastenia gravis: relato de caso Outpatient anesthesia for radiotherapy in a patient with myasthenia gravis: case report

    Directory of Open Access Journals (Sweden)

    Raquel Marcondes Bussolotti

    2006-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A miastenia gravis (MG é doença auto-imune rara, caracterizada pela redução de receptores nicotínicos na junção neuromuscular, com incidência de 14/100.000. O objetivo deste relato foi descrever o caso de paciente portador de miastenia gravis submetido à anestesia geral balanceada, para tratamento radioterápico de carcinoma espinocelular de parótida, em regime ambulatorial. RELATO DO CASO: Paciente do sexo masculino, 87 anos, 87 kg, estado físico ASA III, com história de miastenia gravis; acidente vascular encefálico prévio (AVE; marca-passo por bloqueio atrioventricular total; hipertensão arterial sistêmica (HAS. Foram programadas sete sessões de radioterapia de 20 minutos para tratamento de tumor de parótida, sob anestesia geral. Na sala de radioterapia foi monitorizado com cardioscópio, monitor de pressão arterial não-invasiva, oxímetro de pulso, e submetido à anestesia geral com propofol e sevoflurano. Após a indução, foi mantido em ventilação espontânea com cânula de Guedel e cateter nasofaríngeo com O2 /sevoflurano, para acomodação da máscara imobilizadora. Na sala de recuperação pós-anestésica, não apresentou complicações. CONCLUSÕES: A escolha dos anestésicos e o acompanhamento clínico criterioso permitiram a boa evolução do paciente, com AVE prévio, cardiopata e idoso, submetido à anestesia geral balanceada para procedimento de aplicação de radioterapia, em regime ambulatorial.JUSTIFICATIVA Y OBJETIVOS: La Miastenia Gravis (MG es una enfermedad auto inmune rara, caracterizada por la reducción de receptores nicotínicos en la junción neuromuscular, con incidencia de 14/100.000. El objetivo de este relato fue el de describir el caso del paciente portador de miastenia gravis sometido a la anestesia general balanceada, para tratamiento radioterápico de carcinoma espinocelular de parótida en régimen ambulatorial. RELATO DEL CASO: Paciente del sexo masculino

  8. Anestesia venosa total com infusão alvo-controlada de remifentanil e propofol para ablação de fibrilação atrial Anestesia venosa total con infusión objeto-controlada de remifentanil y propofol para ablación de la fibrilación atrial Total intravenous anesthesia with target-controlled infusion of remifetanil and propofol for ablation of atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Fernando Squeff Nora

    2009-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A ablação de fibrilação atrial (FA é um procedimento novo em nosso meio, embora seja comum em outros centros. A escolha da anestesia, monitores e cuidados anestesiológicos para esse procedimento, realizado fora do bloco cirúrgico, não tem sido descrita. O objetivo deste relato foi descrever uma técnica de anestesia para a realização de ablação de FA. RELATO DO CASO: Paciente feminina, 49 anos, 73 kg, 155 cm, ASA II por hipertensão arterial sistêmica. A monitorização constou de eletrocardiograma com 12 derivações, oximetria de pulso, frequência cardíaca, eletroencefalografia bispectral para medidas de BIS, taxa de supressão (SR e SEF95 e pressão arterial média (PAM. A indução anestésica foi realizada com propofol por via venosa, em infusão alvo-controlada (IAC, com alvo regulado em 4 µg.mL-1, remifentanil por via venosa, em IAC, com alvo de 3 ng.mL¹, e rocurônio por via venosa em bolus na dose de 0,2 mg.kg-1. O modelo farmacocinético de propofol utilizado foi o descrito por Marsh e incorporado à bomba de propofol PFS®. O modelo farmacocinético de remifentanil utilizado foi o descrito por Minto e incorporado à bomba de infusão Alaris PK®. As concentrações, no local efetor ou biofase, corresponderam às informações obtidas através das bombas de infusão e representaram medidas preditivas das concentrações de ambos os fármacos nos respectivos locais de ação. As concentrações de propofol e de remifentanil foram reguladas de acordo com o BIS e a PAM, respectivamente. CONCLUSÕES: A anestesia venosa total para ablação de FA pode ser uma opção segura, levando-se em conta que não há alteração da eletrofisiologia das vias acessórias. A literatura é escassa a este respeito e novas publicações poderão ou não justificar esta modalidade de anestesia durante ablação de FA.JUSTIFICATIVA Y OBJETIVOS: La ablación de fibrilación atrial (FA es un procedimiento nuevo en

  9. Biodistribution and Immunogenicity of Allogeneic Mesenchymal Stem Cells in a Rat Model of Intraarticular Chondrocyte Xenotransplantation

    Directory of Open Access Journals (Sweden)

    Maribel Marquina

    2017-11-01

    Full Text Available Xenogeneic chondrocytes and allogeneic mesenchymal stem cells (MSC are considered a potential source of cells for articular cartilage repair. We here assessed the immune response triggered by xenogeneic chondrocytes when injected intraarticularly, as well as the immunoregulatory effect of allogeneic bone marrow-derived MSC after systemic administration. To this end, a discordant xenotransplantation model was established by injecting three million porcine articular chondrocytes (PAC into the femorotibial joint of Lewis rats and monitoring the immune response. First, the fate of MSC injected using various routes was monitored in an in vivo imaging system. The biodistribution revealed a dependency on the injection route with MSC injected intravenously (i.v. succumbing early after 24 h and MSC injected intraperitoneally (i.p. lasting locally for at least 5 days. Importantly, no migration of MSC to the joint was detected in rats previously injected with PAC. MSC were then administered either i.v. 1 week before PAC injection or i.p. 3 weeks after to assess their immunomodulatory function on humoral and adaptive immune parameters. Anti-PAC IgM and IgG responses were detected in all PAC-injected rats with a peak at week 2 postinjection and reactivity remaining above baseline levels by week 18. IgG2a and IgG2b were the predominant and long-lasting IgG subtypes. By contrast, no anti-MSC antibody response was detected in the cohort injected with MSC only, but infusion of MSC before PAC injection temporarily augmented the anti-PAC antibody response. Consistent with a cellular immune response to PAC in PAC-injected rats, cytokine/chemokine profiling in serum by antibody array revealed a distinct pattern relative to controls characterized by elevation of multiple markers at week 2, as well as increases in proliferation in draining lymph nodes. Notably, systemic administration of allogeneic MSC under the described conditions did not diminish the immune

  10. Intra-articular Analgesia and Discharge to Home Enhance Recovery Following Total Knee Replacement.

    Science.gov (United States)

    Duggal, Shivi; Flics, Susan; Cornell, Charles N

    2015-02-01

    a program with our local home care agency. Outcomes assessed and compared between groups included length of stay, incidence of post-op nausea, dizziness, in-hospital falls, occurrence of complications including wound infection and the recovery of range of motion at 6 weeks, 3 months, and 1 year post-op. Pain control was similar between the groups but Group B had fewer side effects. With the new pathway, length of stay (LOS) was reduced from 4.32 to 3.64 days with a similar LOS reduction across all ASA classes. There was no increase in Group B wound or other complications. Return of ROM was similar between groups. Our findings suggest that replacing PCEA and FNB with intra-articular analgesia with a SNB allows for improved early recovery following TKR. That, combined with pre-op discharge planning and initiation of an intensive home PT program, reduced average length of stay.

  11. SINERGISMO FARMACODINÁMICO. A PROPÓSITO DE UN CASO INTERVENIDO QUIRÚRGICAMENTE DE URGENCIA BAJO ANESTESIA GENERAL.

    Directory of Open Access Journals (Sweden)

    Yesid Pallares Villarreal

    2004-01-01

    Full Text Available Presentamos una paciente femenina geriatrica con antecedentes de hipertensiòn arterial y trastornos psiquiatricos intervenida quirurgicamente de urgencia por un cuadro doloroso abdominal, con una interaccion farmacodinamica por sinergismo del doxepin y captopril potenciada por los efectos de la anestesia general. La hipotensiòn arterial fue la forma clínica de presentación. La paciente se recibió hipotensa por la administración preoperatoria de doxepin tratamiento de base y de captopril tratamiento impuesto por crisis hipertensiva antes de su llegada al hospital. Después de la inducción de la anestesia general desarrolla hipotensión arterial que sólo responde a la administración de noradrenalina. En un inicio se interpreta como un shock séptico en fase hipodinámica por el cuadro doloroso abdominal y la vasoplejia pero descartadas otras causas se concluye como hipotensión arterial de origen farmacológico con relación a la ingestión de antidepresivos triciclicos e inhibidores de la enzima convertora de angiotensina I en angiotensina II por su acción sobre el sistema nervioso simpático por potenciada por los agentes anestésicos. La paciente fue dada de alta del hospital satisfactoriamente a los 7 dias de operada.

  12. Emprego do propofol, isofluorano e morfina para a anestesia geral de longa duração em bezerros

    Directory of Open Access Journals (Sweden)

    Alves G.E.S.

    2003-01-01

    Full Text Available Foram estudadas características da bioquímica do sangue, da pressão arterial e da freqüência de pulso de 12 bezerros mantidos sob anestesia por 13 horas, utilizando-se propofol para a indução e isofluorano para manutenção, associados à administração de morfina intra-tecal. Os valores de freqüência de pulso, pressão arterial e glicemia apresentaram pequenas variações e se mantiveram próximos dos valores de referência para bezerros anestesiados. Ao longo do período de anestesia houve aumento significativo, mas discreto, do hematócrito, hemoglobina, pCO2, CO2 total, bicarbonato e potássio. O pH do sangue, pO2, Na+ e Ca++ apresentaram reduções significativas. Este protocolo anestésico foi seguro para a manutenção de bezerros anestesiados por período prolongado.

  13. Efeitos do óxido nitroso em hipotensão controlada durante anestesia com baixo fluxo

    Directory of Open Access Journals (Sweden)

    Semiha Barçın

    2013-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Investigamos o efeito do óxido nitroso (N2O em hipotensão controlada durante anestesia com baixo fluxo (isoflurano-dexmedetomidina em termos de hemodinâmica, consumo de anestésico e custos. MÉTODOS: Quarenta pacientes foram randomicamente alocados em dois grupos. Infusão de dexmedetomidina (0,1 µg.kg-1.min-1 foi mantida por 10 minutos. Subsequentemente, essa infusão foi mantida até os últimos 30 minutos de operação a uma dose de 0,7 µg.kg-1.hora-1. Tiopental (4-6 mg.kg-1 e brometo de vecurônio (0,08 0,12 mg.kg-1 foram administrados na indução de ambos os grupos. Isoflurano (2% foi administrado para manutenção da anestesia. O Grupo N recebeu uma mistura de 50% de O2-N2O e o Grupo A recebeu uma mistura de 50% de O2-ar como gás de transporte. Anestesia com baixo fluxo (1 L.min-1 foi iniciada após um período de 10 minutos de alto fluxo inicial (4,4 L.min-1. Os valores de pressão arterial, frequência cardíaca, saturação periférica de O2, isoflurano inspiratório e expiratório, O2 inspiratório e expiratório, N2O inspiratório e expiratório, CO2 inspiratório, concentração de CO2 após expiração e concentração alveolar mínima foram registrados. Além disso, as taxas de consumo total de fentanil, dexmedetomidina e isoflurano, bem como de hemorragia, foram determinadas. RESULTADOS: A frequência cardíaca diminuiu em ambos os grupos após a carga de dexmedetomidina. Após a intubação, os valores do Grupo A foram maiores nos minutos um, três, cinco, 10 e 15. Após a intubação, os valores de hipotensão desejados foram alcançados em 5 minutos no Grupo N e em 20 minutos no grupo A. Os valores da CAM foram mais altos no Grupo N nos minutos um, três, cinco, 10 e 15 (p < 0,05. Os valores da FiO2 foram mais altos entre 5 e 60 minutos no Grupo A, enquanto foram mais altos no Grupo N aos 90 minutos (p < 0,05. Os valores de Fi Iso (isoflurano inspiratório foram menores no Grupo N nos minutos

  14. Dilemas bioéticos na prática da anestesia

    Directory of Open Access Journals (Sweden)

    José Abelardo Garcia de Meneses

    2001-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: As relações da sociedade humana com o universo e a aplicação de novos conceitos éticos estudados por filósofos, fundamentalmente para acompanhar a evolução das ciências biomédicas, originaram a Bioética. O objetivo é tratar dos avanços nas relações humanas entre médicos e pacientes, propostos pelos princípios bioéticos em adição aos tradicionais princípios hipocráticos, aqui discutidos no particular da prática desta ciência fascinante a Anestesiologia. O presente trabalho visa estimular e aprofundar as discussões bioéticas na área da Anestesiologia. CONTEÚDO: São discutidos os limites entre o ato médico benevolente e não-maleficente, indissociavelmente comprometido com o bem-estar do paciente, os benefícios da conduta médica paternalista, visando à preservação da saúde e da vida, e do outro lado, o respeito à autonomia do cidadão-doente, potencial paciente, e o seu direito ao consentimento livre, renovável, revogável e plenamente esclarecido para quaisquer atos médicos. CONCLUSÕES: Com base no quanto é apresentado no presente trabalho o anestesiologista deve sempre decidir beneficentemente em defesa da saúde do indivíduo e da sacralidade da vida, entendendo os limites entre a autonomia do paciente e o direito do médico aplicar tratamento arbitrário à revelia da vontade daquele, em obediência aos princípios da beneficência e da não-maleficência, disponibilizando os benefícios da ciência médica (justiça em favor da vida, posto que, em anestesia muitas vezes, há um limite incompreensivelmente tênue entre vida e morte.

  15. Anestesia en la operación de Blalock-Taussig

    Directory of Open Access Journals (Sweden)

    Lincoln de la Parte Pérez

    2001-09-01

    Full Text Available A pesar de los avances en la última década de las técnicas quirúrgicas para la reparación total de los defectos congénitos cianóticos del corazón, aún algunos pacientes necesitan procedimientos quirúrgicos paliativos durante los primeros meses de vida. Se presenta un estudio retrospectivo de 160 pacientes operados con la técnica paliativa de Blalock-Taussig, en el Cardiocentro del Hospital Pediátrico Universitario "William Soler", en el período de 1990 a 1993. Padecían de Tetralogía de Fallot 120 pacientes, 35 de atresia pulmonar y el resto 5, de transposición de los grandes vasos. El fentanyl fue el agente más utilizado en la inducción y mantenimiento de la anestesia y aportó gran estabilidad hemodinámica. Las complicaciones transoperatorias más frecuentes fueron las arritmias cardíacas (25 pacientes, 15,6 % y dentro de éstas, la mayoría extrasístoles ventriculares (18 pacientes. No hubo fallecidos durante el transoperatorio.In spite of the advances achieved by the surgical techniques for the total repair of congenital cyanotic heart defects in the last decade, some patients still need palliative surgical procedures during the first months of life. A retrospective study of 160 patients that were operated on by using Blalock-Taussig palliative technique at the Heart Center of "William Soler" Pediatric Teaching Hospital, from 1990 to 1993, was conducted. 120 patients suffered from Tetralogy of Fallot, 35 from pulmonary atresia, and the other 5 from transposition of great vessels. Fentanyl was the most used agent in the induction and maintenance of anesthesia and it produced a high hemodynamic stability. The most common transoperative complications were cardiac arrhytmias (25 patients, 15.6 % and, within them, the most were ventricular extrasystoles (18 patients. There were no deaths during the transoperative.

  16. El estrabismo en el niño y anestesia Strabismus in the child and anesthesia

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    Joaquín L. de la Lastra Rodríguez

    2001-06-01

    Full Text Available Se analiza el manejo anestésico de 41 niños tratados por estrabismo con anestesia general, administrada a 37 de ellos por vía endotraqueal para la corrección quirúrgica y a los 4 restantes por vía intravenosa para la inyección de toxina botulínica (TBX tipo A en microdosis intraocular. Se destacan aspectos importantes de interés anestesiológico como son las implicaciones clínicas que pudieran resultar del manejo anestésico, los cuidados especiales que requieren estos pacientes, la importancia de la evaluación preoperatoria que considere aspectos de interés especial y propios, etc. No hubo complicaciones transoperatorias. El vómito fue la complicación posoperatoria vista en 6 pacientes y sólo 1 sometido a tratamiento quirúrgico requirió además del mantenimiento de una hidratación intravenosa con la administración de una dosis de dimenhidrinato, antihistamínico de fuerte acción antiemética. Se presenta el manejo anestésico para la inyección intraocular de microdosis de TBX tipo A realizada con buenos resultados con Atropina, Diazepán y Clorhidrato de Ketamina por vía intravenosa.The anesthetic management of 41 children with strabismus treated with general anesthesia is analyzed. 37 of them were administered intratracheal anesthesia for surgical correction and the other 4 intravenous anesthesia for the injection of an intraocular microdose of botulinum toxin A (TBX. Important aspects of anesthesiologic interest as the clinical implications that may result from the anesthetic management, the special care required by these patients, the importance of the preoperative evaluation that takes into account aspects of special interest, of the authors' interest and others, are stressed . There were no transoperative complications. Vomiting was the postoperative complication observed in 6 patients and only one of those who underwent surgery required besides the maintenance of an intravenous hydration the administration of a dose

  17. Eletroacupuntura na anestesia com propofol em cães Electroacupuncture on propofol anaesthesia in dogs

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    Renata Navarro Cassu

    2008-09-01

    Full Text Available Resultados satisfatórios têm sido relatados com o emprego da eletroacupuntura (EA, como adjuvante da anestesia geral no homem e em animais. O objetivo do trabalho é avaliar a dose de indução anestésica do propofol em função do emprego da eletroacupuntura em cães. Foram utilizados 20 cães, distribuídos em dois grupos de igual número, GEA: foi realizada EA nos acupontos estômago 36 (E36, vesícula biliar 34 (VB 34 e baço-pâncreas 6 (BP 6, bilateralmente, durante 45 minutos antes da indução anestésica e GC: não foi realizada EA antes da indução anestésica. Os animais foram tranqüilizados com acepromazina intravenosa (0,05mg.kg-1 60 minutos antes da indução anestésica, realizada com propofol na taxa de 0,2ml.kg.min-1. A análise estatística foi realizada por test t não pareado(PElectro-acupuncture (EA has been used as an adjuvant of general anesthesia in men and animals. The aim of this study was to evaluate the effect of EA on propofol dose for induction of anesthesia in dogs. Twenty healthy adult crossbred dogs were used and randomly distributed in two groups (n=10 per group: GEA dogs were submitted to EA in the acupoints stomach 36, gall bladder 34 and spleen 6, bilaterally, for 45 minutes before induction of anesthesia. Dogs in the control group (GC were not treated before induction of anesthesia. Animals were sedated with 0.05mg kg-1 of acepromazine intravenously. Anesthesia was induced with intravenous propofol using a 0.2ml.kg.min-1 infusion rate 60 minutes after sedation. The statistical analysis was accomplished by the unpaired t test to compare differences between groups (P<0.05. Values are presented as mean±SD. There was no significant difference in the dose of propofol required to abolish the podal withdrawal reflex between groups (5.0±2.0mg kg-1 for the control group and 5.2±1.6mg kg-1 for the EA treated group, suggesting that EA did not potentiate propofol anesthesia in dogs.

  18. Development of a versatile intra-articular pressure sensing array.

    Science.gov (United States)

    Welcher, J B; Popovich, J M; Hedman, T P

    2011-10-01

    A new sensor array intended to accurately and directly measure spatial and time-dependent pressures within a highly curved biological intra-articular joint was developed and tested. To evaluate performance of the new sensor array for application within intra-articular joints generally, and specifically to fit within the relatively restrictive space of the lumbar spine facet joint, geometric constraints of length, width, thickness and sensor spatial resolution were evaluated. Additionally, the effects of sensor array curvature, frequency response, linearity, drift, hysteresis, repeatability, and total system cost were assessed. The new sensor array was approximately 0.6mm in thickness, scalable to below the nominal 12 mm wide by 15 high lumbar spine facet joint size, offered no inherent limitations on the number or spacing of the sensors with less than 1.7% cross talk with sensor immediately adjacent to one another. No difference was observed in sensor performance down to a radius of curvature of 7 mm and a 0.66±0.97% change in sensor sensitivity was observed at a radius of 5.5mm. The sensor array had less than 0.07 dB signal loss up to 5.5 Hz, linearity was 0.58±0.13% full scale (FS), drift was less than 0.2% FS at 250 s and less than 0.6% FS at 700 s, hysteresis was 0.78±0.18%. Repeatability was excellent with a coefficient of variation less than 2% at pressures between 0 and 1.000 MPa. Total system cost was relatively small as standard commercially available data acquisition systems could be utilized, with no specialized software, and individual sensors within an array can be replaced as needed. The new sensor array had small and scalable geometry and very acceptable intrinsic performance including minimal to no alteration in performance at physiologically relevant ranges of joint curvature. Copyright © 2011 IPEM. Published by Elsevier Ltd. All rights reserved.

  19. Intra-articular gouty tophi of the knee: CT and MR imaging in 12 patients

    International Nuclear Information System (INIS)

    Chen, C.K.H.; Yeh Lee Ren; Pan Huay-Ben; Yang Chien-Fang; National Yang-Ming Univ., Taipei; Lu Yih-Chau; Wang Jyh-Seng; Resnick, D.; California Univ., Los Angeles, CA

    1999-01-01

    Objective. To define the imaging characteristics of intra-articular tophi of the knee. Design and patients. Twelve patients with intra-articular tophi in the knee were studied with routine MR imaging, gadolinium (Gd)-enhanced MR imaging, and CT over a 4-year period. There were 11 men and one woman, 25-82 years of age (mean age 48 years). Four patients did not have a documented history of gout at the time of the MR examination. The diagnosis of intra-articular tophi was provided by arthroscopy and histological examination (5 patients), by microscopic study of joint fluid (5 patients), or by characteristic clinical, laboratory and imaging findings (2 patients). Results. In 15 MR examinations the tophi were located purely intra-articularly in 10 knees. In the remaining five MR studies, periarticular soft tissues or bone, or both, were involved. All the intra-articular tophi manifested low to intermediate signal intensity on both T1- and T2-weighted images. All five Gd-enhanced MR examinations demonstrated a heterogeneous peripheral enhancement. All 10 CT scans showed varying degrees of stippled calcifications within the tophi. The nature of the calcifications was confirmed on histological examination in three patients. Conclusion. Presenting clinical manifestations of gout may relate to intra-articular tophaceous deposits. Such deposits present as masses on MR images with low to intermediate signal intensity on both T1- and T2-weighted images and a characteristic enhancement pattern following intravenous Gd administration. These features relate primarily to internal calcifications, which are most evident on CT images. MR evaluation (including Gd administration) supplemented, in some cases, with CT scanning allows accurate diagnosis of intra-articular tophaceous deposits. (orig.)

  20. Arthroscopic ankle arthrodesis with intra-articular distraction.

    Science.gov (United States)

    Kim, Hyong Nyun; Jeon, June Young; Noh, Kyu Cheol; Kim, Hong Kyun; Dong, Quanyu; Park, Yong Wook

    2014-01-01

    Arthroscopic ankle arthrodesis has shown high rates of union comparable to those with open arthrodesis but with substantially less postoperative morbidity, shorter operative times, less blood loss, and shorter hospital stays. To easily perform arthroscopic resection of the articular cartilage, sufficient distraction of the joint is necessary to insert the arthroscope and instruments. However, sometimes, standard noninvasive ankle distraction will not be sufficient in post-traumatic ankle arthritis, with the development of arthrofibrosis and joint contracture after severe ankle trauma. In the present report, we describe a technique to distract the ankle joint by inserting a 4.6-mm stainless steel cannula with a blunt trocar inside the joint. The cannula allowed sufficient intra-articular distraction, and, at the same time, a 4.0-mm arthroscope can be inserted through the cannula to view the joint. Screws can be inserted to fix the joint under fluoroscopic guidance without changing the patient's position or removing the noninvasive distraction device and leg holder, which are often necessary during standard arthroscopic arthrodesis with noninvasive distraction. Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  1. Intra-articular knee temperature changes: ice versus cryotherapy device.

    Science.gov (United States)

    Warren, Todd A; McCarty, Eric C; Richardson, Airron L; Michener, Todd; Spindler, Kurt P

    2004-03-01

    Cryotherapy is commonly applied without research documenting the intra-articular (IA) temperature changes or subject discomfort between ice and a cryotherapy device. The null hypothesis is that no difference would be observed in IA temperature decline or subject tolerance between ice and the cryotherapy device in normal knees. Prospective, within-subject controlled clinical trial. Twelve subjects had IA temperature in suprapatellar pouch and skin recorded bilaterally after application of cryotherapy versus ice. Subject tolerance was recorded by 10-cm visual analog scale (VAS). Statistical evaluation was by Spearman's correlation analysis and paired, nonparametric Wilcoxon's signed rank test. Both significantly lowered (P cryotherapy) at 30 (3.3 degrees C/2.2 degrees C), 60 (12.8 degrees C/7.1 degrees C), and 90 (15.2 degrees C/9.7 degrees C) minutes. However, ice lowered the IA temperature significantly more than the cryotherapy device (P < 0.001) and was more painful by VAS at 30 and 60 minutes (P < 0.01). Both methods produced large declines in skin and IA temperatures. However, ice was more effective yet resulted in higher pain scores. The authors hypothesize that IA temperatures below a threshold are associated with increased perceived pain.

  2. Intracortical chondroblastoma mimicking intra-articular osteoid osteoma

    Energy Technology Data Exchange (ETDEWEB)

    Ishida, Tsuyoshi; Mukai, Kiyoshi [First Department of Pathology, Tokyo Medical University, Shinjuku 6-1-1, Shinjuku-ku, Tokyo 160-8402 (Japan); Goto, Takahiro [Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo (Japan); Motoi, Noriko [Department of Pathology, Toranomon Hospital, Tokyo (Japan)

    2002-10-01

    We report a case of intra-articular intracortical chondroblastoma of the femoral condyle which radiologically appeared to be osteoid osteoma. A 19-year-old woman presented with a 3-year history of gradually increasing pain in the right knee and had been on nonsteroidal anti-inflammatory drugs for pain relief. Laboratory data were within normal limits. Radiographs showed a well-demarcated lucent lesion in the medial condyle of the right femur. A nidus-like lesion with calcifications and a sclerotic rim located in the cortex was imaged by computed tomography scan. Magnetic resonance imaging revealed bone marrow edema and soft tissue swelling around the lesion, with low signal intensity of the nidus-like lesion on both T1- and T2-weighted images. The lesion was excised en bloc and the histological diagnosis of chondroblastoma was made. A mild inflammatory reaction was observed in the bone marrow and synovium around the tumor. The chondroblastoma cells were shown to express cyclooxygenase-2 with immunohistochemistry. (orig.)

  3. Early Intra-Articular Complement Activation in Ankle Fractures

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    Hagen Schmal

    2014-01-01

    Full Text Available Cytokine regulation possibly influences long term outcome following ankle fractures, but little is known about synovial fracture biochemistry. Eight patients with an ankle dislocation fracture were included in a prospective case series and matched with patients suffering from grade 2 osteochondritis dissecans (OCD of the ankle. All fractures needed external fixation during which joint effusions were collected. Fluid analysis was done by ELISA measuring aggrecan, bFGF, IL-1β, IGF-1, and the complement components C3a, C5a, and C5b-9. The time periods between occurrence of fracture and collection of effusion were only significantly associated with synovial aggrecan and C5b-9 levels (P<0.001. Furthermore, synovial expressions of both proteins correlated with each other (P<0.001. Although IL-1β expression was relatively low, intra-articular levels correlated with C5a (P<0.01 and serological C-reactive protein concentrations 2 days after surgery (P<0.05. Joint effusions were initially dominated by neutrophils, but the portion of monocytes constantly increased reaching 50% at day 6 after fracture (P<0.02. Whereas aggrecan and IL-1β concentrations were not different in fracture and OCD patients, bFGF, IGF-1, and all complement components were significantly higher concentrated in ankle joints with fractures (P<0.01. Complement activation and inflammatory cell infiltration characterize the joint biology following acute ankle fractures.

  4. Intraarticular Pulsed Radiofrequency to Treat Refractory Lumbar Facet Joint Pain in Patients with Low Back Pain.

    Science.gov (United States)

    Chang, Min Cheol; Cho, Yun-Woo; Ahn, Da Hyun; Do, Kyung Hee

    2018-04-01

    Many treatment techniques have been used for refractory lumbar facet joint pain; however, their efficacy has been controversial. In this study, we investigated the clinical efficacy and safety of intra-articular pulsed radiofrequency for the treatment of refractory lumbar facet joint pain in patients with low back pain. Twenty patients with refractory lumbar facet joint pain were recruited, and each patient was treated via intra-articular pulsed radiofrequency. The treatment effects were measured with a numerical rating scale, and the technical accuracy of intra-articular pulsed radiofrequency treatment was evaluated independently by 2 radiologists. Any adverse events or complications also were checked. We performed intra-articular pulsed radiofrequency treatment at 48 levels of the lumbar facet joints in 20 patients (5 men and 15 women; mean age, 64.50 ± 10.65 years) with refractory lumbar facet joint pain. Pain scores were significantly reduced at 1 month, 3 months, and 6 months after treatment (P radiofrequency results in all 20 patients, without any serious adverse effects. Treatment using intra-articular pulsed radiofrequency is an alternative to other techniques in patients with refractory lumbar facet joint pain. Copyright © 2018 Elsevier Inc. All rights reserved.

  5. Blood Glucose Levels Following Intra-Articular Steroid Injections in Patients with Diabetes: A Systematic Review.

    Science.gov (United States)

    Choudhry, M N; Malik, R A; Charalambous, Charalambos Panayiotou

    2016-03-22

    Parenterally administered steroids have been shown to affect the metabolism of glucose and to cause abnormal blood glucose levels in diabetic patients. These abnormal blood glucose levels in diabetic patients raise concerns that intra-articular steroid injections also may affect blood glucose levels. We performed a systematic review of studies examining the effect of intra-articular steroid injections on blood glucose levels in patients with diabetes mellitus. A literature search of the PubMed, EMBASE, AMED, and CINAHL databases using all relevant keywords and phrases revealed 532 manuscripts. After the application of inclusion criteria, seven studies with a total of seventy-two patients were analyzed. All studies showed a rise in blood glucose levels following intra-articular steroid injection. Four of the seven studies showed a substantial increase in blood glucose. Peak values reached as high as 500 mg/dL. The peak increase in blood glucose did not occur immediately following intra-articular steroid injection, and in some cases it took several days to occur. In many patients, post-injection hyperglycemia occurred within twenty-four to seventy-two hours. Intra-articular steroid injections may cause hyperglycemia in patients with diabetes mellitus, and patients should be warned of this complication. Diabetic patients should be advised to regularly monitor their blood glucose levels for up to a week after injection and should seek medical advice if safe thresholds are breached. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  6. Anestesia em paciente com insensibilidade congênita a dor e anidrose Anestesia en paciente con insensibilidad congénita al dolor y anhidrosis Anesthesia in a patient with congenital insensitivity to pain and anhidrosis

    Directory of Open Access Journals (Sweden)

    Carlos Rogério Degrandi Oliveira

    2009-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A insensibilidade congênita a dor e anidrose (ICDA ou neuropatia hereditária sensorial e autonômica tipo IV (NHSA tipo IV é neuropatia autossômica recessiva rara do grupo das neuropatias hereditárias sensoriais e autonômicas (NHSA, caracterizada por insensibilidade ao estímulo doloroso, anidrose e retardo mental. Existem poucos relatos sobre a conduta anestésica em pacientes com ICDA devido sua extrema raridade. O objetivo deste relato foi apresentar a conduta anestésica em paciente com ICDA submetida à artrodese de tornozelo esquerdo com colocação de haste e discutir as características de interesse para a anestesia nestes pacientes. RELATO DO CASO: Paciente com história de ICDA foi admitida para artrodese de tornozelo esquerdo devido à artropatia de Charcot. Na sala de operação foi monitorizada com eletrocardiógrafo, índice bispectral, SEF 95%, pressão arterial não invasiva e saturação periférica da hemoglobina, medicada com midazolam como pré-anestésico e submetida à anestesia venosa com propofol e cisatracúrio. Não houve a necessidade de administração de analgésicos. Após intubação traqueal, foi acrescentada monitorização da pressão expiratória final do gás carbônico e da temperatura esofágica. Não apresentou complicações no período perioperatório. Teve alta hospitalar no segundo dia de pós-operatório. CONCLUSÕES: Embora apresentem insensibilidade à dor, alguns pacientes apresentam hiperestesia tátil, o que poderia causar sensações desagradáveis durante a manipulação cirúrgica. Apesar de relatos na literatura de pacientes submetidos a bloqueios no neuroeixo e até mesmo a procedimentos sem anestesia, neste caso utilizou-se a anestesia venosa que proporcionou condições adequadas para o procedimento anestésico-cirúrgico.JUSTIFICATIVA Y OBJETIVOS: La falta de sensibilidad congénita al dolor y la anhidrosis (ICDA o neuropatía hereditaria sensorial y auton

  7. Anestesia venosa total para laringectomia parcial em paciente na 28ª semana de gestação: relato de caso Anestesia venosa total para laringectomía parcial en paciente en la 28ª semana de embarazo: relato de caso Total intravenous anesthesia for partial laryngectomy in 28 weeks pregnant patient: case report

    OpenAIRE

    José Costa; Dalva Maria Carvalho Mendes; José Eduardo de Oliveira Lobo; Adriana Barrozo Ribeiro Furuguem; Gabriel Gilberto Santos

    2005-01-01

    JUSTIFICATIVA E OBJETIVOS: Uma anestesia para paciente gestante constitui um desafio ao anestesiologista em virtude dos riscos para a mãe e para o feto. São muitas as complicações descritas pela literatura como malformações fetais, parto prematuro, instabilidade hemodinâmica materna e até morte fetal. O objetivo deste caso é mostrar uma paciente gestante de 28 semanas, submetida a laringectomia parcial sob anestesia geral venosa total com propofol, remifentanil e cisatracúrio. RELATO DO CASO:...

  8. Usos do sulfato de magnésio em obstetrícia e em anestesia Usos del sulfato de magnesio en obstetricia y en anestesia Applications of Magnesium Sulfate in Obstetrics and Anesthesia

    Directory of Open Access Journals (Sweden)

    Fabiano Timbó Barbosa

    2010-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O magnésio é um íon predominantemente intracelular. Seu efeito bloqueador do receptor NMDA lhe confere características analgésicas e sedativas. O objetivo desse artigo foi revisar a fisiologia, a farmacologia e a diminuição da concentração plasmática do magnésio, assim como algumas das suas aplicações em obstetrícia e em anestesia. CONTEÚDO: O magnésio é um cátion intracelular que possui múltiplas funções: é cofator de enzimas do metabolismo glicídico e de enzimas da degradação dos ácidos nucleicos, proteínas e ácidos graxos; regula a passagem de íons transmembrana e intervém na atividade de várias enzimas. O paciente em estado crítico apresenta tendência à hipomagnesemia e o tratamento consiste em corrigir a causa quando possível acompanhada da reposição do magnésio. Já foi demonstrada a redução da concentração alveolar m��nima (CAM dos agentes inalatórios em animais e do uso de opioides em humanos sob anestesia. CONCLUSÕES: O sulfato de magnésio vem sendo utilizado em obstetrícia com boa efetividade para inibição do trabalho de parto prematuro e para o tratamento das crises convulsivas associadas ao quadro de eclâmpsia. É um fármaco com potencial analgésico e sedativo que pode ser utilizado como coadjuvante durante a anestesia geral atenuando a resposta pressórica à intubação traqueal e diminuindo a necessidade de anestésicos.JUSTIFICATIVA Y OBJETIVOS: El magnesio es un ión predominantemente intracelular. Su efecto bloqueador del receptor NMDA le confiere características analgésicas y sedativas. El objetivo de este artículo, fue revisar la fisiología, la farmacología y la disminución de la concentración plasmática del magnesio, como también de algunas de sus aplicaciones en obstetricia y en anestesia. CONTENIDO: El magnesio es un catión intracelular que posee múltiples funciones: es cofactor de enzimas del metabolismo glicídico y de enzimas de

  9. Anestesia em paciente com síndrome de Rubinstein-Taybi: relato de caso Anestesia en paciente con síndrome de Rubinstein-Taybi: relato de caso Anesthesia in patient with Rubinstein-Taybi syndrome: case report

    Directory of Open Access Journals (Sweden)

    Carlos Rogério Degrandi Oliveira

    2005-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A síndrome de Rubinstein-Taybi (SRT é uma doença genética causada por uma mutação ou apagamento do cromossomo 16, caracterizada por retardo físico e mental, anormalidades craniofaciais e hálux e polegares largos. Há pouca informação sobre esta síndrome na literatura anestésica. O objetivo deste relato foi apresentar a conduta anestésica em paciente submetido à cirurgia odontológica e discutir as características de interesse para a anestesia nesses pacientes. RELATO DO CASO: Paciente do sexo masculino, 9 anos, 28 kg, submetido à anestesia geral para extrações de dentes anormalmente posicionados. Apresentava as características típicas da SRT, retardo físico e mental, anormalidades craniofaciais e hálux e polegares largos. A anestesia foi induzida e mantida com sevoflurano, inicialmente sob máscara facial e após intubação nasotraqueal em ventilação assistida manual com sistema de Bain. Não houve intercorrências e a cirurgia foi realizada em regime ambulatorial. CONCLUSÕES: A importância da avaliação pré-anestésica é enfatizada, devido às malformações, inclusive cardíacas, associadas a esta síndrome. Este paciente, em particular, não apresentava comprometimento cardíaco, presente em um terço dos casos. É recomendável preparação para possível dificuldade de manutenção das vias aéreas.JUSTIFICATIVA Y OBJETIVOS: El síndrome de Rubinstein-Taybi (SRT es una enfermedad genética causada por una mutación o apagamiento del cromosoma 16, caracterizada por retardo físico y mental, anormalidades craneofaciales y hálux y pulgares anchos. Hay poca información sobre este síndrome en la literatura anestésica. El objetivo de este relato ha sido en presentar la conducta anestésica en paciente sometido a cirugía odontológica y discutir las características de interés para la anestesia en estos pacientes. RELATO DEL CASO: Paciente del sexo masculino, 9 años, 28 kg, sometido a

  10. Clinicopathologic findings following intra-articular injection of autologous and allogeneic placentally derived equine mesenchymal stem cells in horses.

    Science.gov (United States)

    Carrade, Danielle D; Owens, Sean D; Galuppo, Larry D; Vidal, Martin A; Ferraro, Gregory L; Librach, Fred; Buerchler, Sabine; Friedman, Michael S; Walker, Naomi J; Borjesson, Dori L

    2011-04-01

    The development of an allogeneic mesenchymal stem cell (MSC) product to treat equine disorders would be useful; however, there are limited in vivo safety data for horses. We hypothesized that the injection of self (autologous) and non-self (related allogeneic or allogeneic) MSC would not elicit significant alterations in physical examination, gait or synovial fluid parameters when injected into the joints of healthy horses. Sixteen healthy horses were used in this study. Group 1 consisted of foals (n = 6), group 2 consisted of their dams (n = 5) and group 3 consisted of half-siblings (n = 5) to group 1 foals. Prior to injection, MSC were phenotyped. Placentally derived MSC were injected into contralateral joints and MSC diluent was injected into a separate joint (control). An examination, including lameness evaluation and synovial fluid analysis, was performed at 0, 24, 48 and 72 h post-injection. MSC were major histocompatibility complex (MHC) I positive, MHC II negative and CD86 negative. Injection of allogeneic MSC did not elicit a systemic response. Local responses such as joint swelling or lameness were minimal and variable. Intra-articular MSC injection elicited marked inflammation within the synovial fluid (as measured by nucleated cell count, neutrophil number and total protein concentration). However, there were no significant differences between the degree and type of inflammation elicited by self and non-self-MSC. The healthy equine joint responds similarly to a single intra-articular injection of autologous and allogeneic MSC. This pre-clinical safety study is an important first step in the development of equine allogeneic stem cell therapies.

  11. Feocromocitoma y anestesia: Revisión del tema a propósito de un caso

    Directory of Open Access Journals (Sweden)

    Yolanda Sotolongo Molina

    2002-12-01

    Full Text Available Se reporta el caso de un paciente al cual se le realizó resección de un feocromocitoma en el Instituto de Nefrología. Se describen sus antecedentes, anestesia general orotraqueal, control hemodinámico con lidocaína y nitropusiato de sodio y monitoreo transoperatorio empleado. Se realizó una revisión bibliográfica a través del Medline, a la luz de los conocimientos actuales de la atención perioperatoria, métodos anestésicos, terapéutica con vasodilatadores, bloqueadores alfa y beta adrenérgicos, sulfato de magnesio y bloqueadores de los canales de calcio utilizados en el paciente con feocromocitoma

  12. Intra-articular Nodular Fasciitis: An Unexpected Diagnosis for a Joint Lesion: A Case Report

    Directory of Open Access Journals (Sweden)

    MF Michelle Chan

    2014-07-01

    Full Text Available Pathological lesions in and around a joint can arise from underlying dermis, subcutis, deep muscle, bone or synovium. Clinical presentation can include joint pain, joint swelling, palpable masses and mechanical restriction. Whilst giant cell tumour of tendon sheath, pigmented villonodular synovitis, synovial chondromatosis, lipoma arborescens, juxta articular myxomas and inflammatory arthritis are the better-known conditions of the joint. Intra-articular nodular fasciitis, on the other hand, is less well recognized both clinically and radiologically. It is rarely seen in routine practice and is only described in case reports in the literature. Due to the non-specific clinical and radiological findings as well as the unfamiliarity with the entity, the diagnosis of intra-articular nodular fasciitis is usually clinched only after histological examination. We present a case of intra-articular nodular fasciitis arising in the knee joint which was not suspected clinically or radiologically.

  13. Usefulness of fluoroscopy-guided intra-articular injection of the knee

    Energy Technology Data Exchange (ETDEWEB)

    Myung, Jae Sung; Lee, Joon Woo [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of); Lee, Ji Yeon [Kangwon National University College of Medicine, Chuncheon (Korea, Republic of)] (and others)

    2007-06-15

    To determine the accuracy of the intra-articular location of hyaluronic acid injection using a blind approach and to establish the usefulness of fluoroscopy-guided intra-articular injection. A fluoroscopy unit was used for 368 intra-articular injections of hyaluronic acid to 93 knees in 65 patients. Initially, blind needle positioning was conducted on the fluoroscopy table. The failure rate of the blind approach among the 368 injections was evaluated, and a relationship between the Kellgren-Lawrence grade (K-L grade) and the incidence of repeated failures using the blind approach was determined for injections to 52 knees in 37 patients who received a complete cycle of injections (five consecutive injections with a one-week interval between injections). Using a blind approach, 298 of 368 trials (81.2%) resulted in a needle tip being placed in an intra-articular location, while 70 of 368 trials resulted in an extra-articular placement of the needle tip. Among 52 knees to which a complete cycle of injection (five consecutive injections with a one-week interval between injections) was administered, repeated failure of intra-articular placement using the blind approach was seen for 18 knees (34.6%); a more severe K-L grade assigned was associated with a higher rate of repeated failure. However, the trend was not statistically significant based on the Chi-squared test ({rho} value = 0.14). Fluoroscopy-guided needle placement may be helpful to ensure therapeutic intra-articular injection of the knee.

  14. Usefulness of fluoroscopy-guided intra-articular injection of the knee

    International Nuclear Information System (INIS)

    Myung, Jae Sung; Lee, Joon Woo; Lee, Ji Yeon

    2007-01-01

    To determine the accuracy of the intra-articular location of hyaluronic acid injection using a blind approach and to establish the usefulness of fluoroscopy-guided intra-articular injection. A fluoroscopy unit was used for 368 intra-articular injections of hyaluronic acid to 93 knees in 65 patients. Initially, blind needle positioning was conducted on the fluoroscopy table. The failure rate of the blind approach among the 368 injections was evaluated, and a relationship between the Kellgren-Lawrence grade (K-L grade) and the incidence of repeated failures using the blind approach was determined for injections to 52 knees in 37 patients who received a complete cycle of injections (five consecutive injections with a one-week interval between injections). Using a blind approach, 298 of 368 trials (81.2%) resulted in a needle tip being placed in an intra-articular location, while 70 of 368 trials resulted in an extra-articular placement of the needle tip. Among 52 knees to which a complete cycle of injection (five consecutive injections with a one-week interval between injections) was administered, repeated failure of intra-articular placement using the blind approach was seen for 18 knees (34.6%); a more severe K-L grade assigned was associated with a higher rate of repeated failure. However, the trend was not statistically significant based on the Chi-squared test (ρ value = 0.14). Fluoroscopy-guided needle placement may be helpful to ensure therapeutic intra-articular injection of the knee

  15. Inflammatory Microenvironment Persists After Bone Healing in Intra-articular Ankle Fractures.

    Science.gov (United States)

    Adams, Samuel B; Leimer, Elizabeth M; Setton, Lori A; Bell, Richard D; Easley, Mark E; Huebner, Janet L; Stabler, Thomas V; Kraus, Virginia B; Olson, Steven A; Nettles, Dana L

    2017-05-01

    Post-traumatic osteoarthritis (PTOA) is responsible for the majority of cases of ankle arthritis. While acute and end-stage intra-articular inflammation has previously been described, the state of the joint between fracture healing and end-stage PTOA remains undefined. This study characterized synovial fluid (SF) composition of ankles after bone healing of an intra-articular fracture to identify factors that may contribute to the development of PTOA. Of an original 21 patients whose SF was characterized acutely following intra-articular ankle fractures, 7 returned for planned hardware (syndesmotic screw) removal after bone healing (approximately 6 months) and consented to a second bilateral SF collection. SF concentrations of 15 cytokines and matrix metalloproteinases (MMPs) and 2 markers each of cartilage catabolism (CTXII and glycosaminoglycan) and hemarthrosis (biliverdin and bilirubin) were compared for previously fractured and contralateral, uninjured ankles from the same patient. Analysis was also performed to determine the effect of the number of fracture lines and involvement of soft tissue on SF composition. Interleukin (IL)-6, IL-8, MMP-1, MMP-2, and MMP-3 were significantly elevated in the SF from healed ankles compared to matched contralateral uninjured ankles at approximately 6 months after fracture. There were no differences in markers of cartilage catabolism or hemarthrosis. Only IL-1α was affected by the number of fracture lines while differences were not detected for other analytes or with respect to the involvment of soft tissue. Sustained intra-articular inflammation, even after complete bone healing, was suggested by elevations of pro-inflammatory cytokines (IL-6 and IL-8). In addition, elevated concentrations of MMPs were also noted and were consistent with a persistent inflammatory environment. This study suggests new evidence of persistent intra-articular inflammation after intra-articular ankle fracture healing and suggests potential

  16. Intra-Articular Analgesia and Steroid Reduce Pain Sensitivity in Knee OA Patients

    DEFF Research Database (Denmark)

    Jørgensen, Tanja Schjødt; Graven-Nielsen, Thomas; Ellegaard, Karen

    2014-01-01

    Objectives. To assess the effects of intra-articular therapy on pain sensitivity in the knee and surrounding tissues in knee OA patients. Methods. Twenty-five knee OA patients with symptomatic knee OA were included in this interventional cohort study. Pressure pain thresholds (PPT) were recorded...... muscles (control site). Results. Significantly increased PPTs were found following intra-articular injection, at both the knee (P effects were sustained for two weeks, and at some points the effect was even greater at two weeks (P 

  17. The Effect of Preoperative Intra-Articular Methylprednisolone on Pain After TKA

    DEFF Research Database (Denmark)

    Luna, Iben E; Kehlet, Henrik; Jensen, Claus M

    2017-01-01

    In a randomized, double-blind, placebo controlled trial, we investigated the postoperative analgesic effect of a single intra-articular injection of 40 mg methylprednisolone acetate (MP) administered 1 week before total knee arthroplasty (TKA). Forty-eight patients with high pain osteoarthritis (≥5...... groups in postoperative sensitization was found (P > .4) despite reduced preoperative intra-articular inflammation (IL-6) in the MP group versus placebo (median change in IL-6 = -70 pg/mL, interquartile range = -466 to 0 vs. 32 pg/mL, interquartile range = -26 to 75, P = .029). Alternative central...

  18. Comparative efficacy of intra-articular hyaluronic acid and corticoid injections in osteoarthritis of the first carpometacarpal joint: results of a 6-month single-masked randomized study.

    Science.gov (United States)

    Monfort, Jordi; Rotés-Sala, Delfin; Segalés, Nuria; Montañes, Francisco-Jose; Orellana, Cristobal; Llorente-Onaindia, Jone; Mojal, Sergi; Padró, Isabel; Benito, Pere

    2015-03-01

    The study aim was to compare the efficacy and safety of ultrasound-guided intra-articular injections of hyaluronic acid and betamethasone in the management of patients with osteoarthritis of the thumb. Eighty-eight evaluable patients diagnosed with osteoarthritis of the thumb (Kellgren-Lawrence grade II-III) received ultrasound-guided intra-articular treatment with hyaluronic acid (48) or betamethasone (40). In total, 3 local injections were scheduled at 7-day intervals. Assessments were performed at baseline and at 7, 14, 30, 90, and 180 days. In both study groups, the pain Visual Analogue Scale and Functional Index for Hand Osteoarthritis scores decreased significantly during follow-up compared to baseline. There were no significant differences between the groups. However, at 90 days, the functional score showed a trend towards greater clinical improvement in the hyaluronic acid group (P 0.071). A subanalysis of patients with Functional Index score≥5 and Visual Analogue Scale score≥3 at baseline showed a significantly higher median functionality score in the hyaluronic acid group (P 0.005 at 90 days and P 0.020 at 180 days). Further limiting analysis to a baseline pain score≥5 showed significantly greater improvement in functionality score (P 0.004 at 180 days), which was already apparent after the second intra-articular injection at 14 days (P 0.028). In this patient subset, the mean pain score also improved significantly at 180 days (P 0.02). Both hyaluronic acid and betamethasone were effective and well-tolerated for the management of rhizarthrosis. Hyaluronic acid was more effective over time and more efficiently improved functionality and pain in patients with more severe symptoms. Copyright © 2014 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

  19. Anestesia peridural contínua com ropivacaína a 0,2% associada a anestesia geral para cirurgia do abdômen superior em crianças Anestesia peridural contínua con ropivacaína a 0,2% asociada a anestesia general para cirugía del abdomen superior en niños Continuous epidural anesthesia with 0.2% ropivacaine associated to general anesthesia for upper abdominal surgery in children

    Directory of Open Access Journals (Sweden)

    Jyrson Guilherme Klamt

    2003-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Técnicas anestésicas têm sido empregadas em pacientes pediátricos para vários tipos de cirurgias, apresentando entre outras vantagens, a analgesia pós-operatória. O objetivo deste estudo foi avaliar o ritmo de infusão de propofol e a recuperação pós-anestésica de crianças submetidas à cirurgia abdominal alta sob anestesia peridural torácica com ropivacaína a 0,2%, associada à anestesia geral com propofol ou propofol mais sufentanil. MÉTODO: Vinte e seis crianças ASA I, II e III, com idades entre 0 e 4 anos, submetidas à cirurgia abdominal alta foram selecionadas para anestesia peridural torácica (T7-T8 com ropivacaína a 0,2% (1,5 ml.kg-1. Foram divididas aleatoriamente em dois grupos: Propofol (infusão de propofol e Sufentanil (infusão de propofol mais sufentanil 1 µg.kg-1. Os ritmos de infusões de propofol foram de 20 e 10 mg.kg-1.h-1 nos grupos Propofol e Sufentanil, respectivamente, ajustadas de modo a manter a pressão arterial cerca de 20% dos valores pré-indução e interrompidas 10 a 15 minutos antes do final estimado da cirurgia. A recuperação pós-anestésica foi avaliada através de uma escala modificada de Aldrete-Kroulik e a sedação avaliada através de uma escala de 5 pontos. RESULTADOS: Duas crianças de cada grupo foram excluídas por problemas técnicos. O ritmo de infusão foi significativamente menor no grupo Sufentanil em relação ao grupo Propofol durante 100 minutos após o início da cirurgia. Os tempos para extubação e transferência para a sala de recuperação pós-anestésica (SRPA foram significativamente menores no grupo Propofol, porém a intensidade e a duração da sedação foram maiores nesse grupo em relação ao grupo Sufentanil. Os escores de recuperação foram similares nos dois grupos. Após 3 horas na SRPA, todos pacientes haviam atingido os critérios para transferência para as enfermarias. Hipotensão arterial transitória foi observada em 2

  20. Occult Intra-articular Knee Injuries in Children With Hemarthrosis.

    Science.gov (United States)

    Askenberger, Marie; Ekström, Wilhelmina; Finnbogason, Thröstur; Janarv, Per-Mats

    2014-07-01

    Hemarthrosis after acute knee trauma is a sign of a potentially serious knee injury. Few studies have described the epidemiology and detailed injury spectrum of acute knee injuries in a general pediatric population. To document the current injury spectrum of acute knee injuries with hemarthrosis in children aged 9 to 14 years and to describe the distribution of sex, age at injury, type of activity, and activity frequency in this population. Descriptive epidemiology study. All patients in the Stockholm County area aged 9 to 14 years who suffered acute knee trauma with hemarthrosis were referred to Astrid Lindgren Children's Hospital, Karolinska University Hospital, from September 2011 to April 2012. The patients underwent clinical examination, radiography, and magnetic resonance imaging (MRI). The type of activity when injured, regular sports activity/frequency, and patient sex and age were registered. The diagnoses were classified into minor and serious injuries. The study included 117 patients (47 girls and 70 boys; mean age, 13.2 years). Seventy percent had a serious knee injury. Lateral patellar dislocations, anterior cruciate ligament ruptures, and anterior tibial spine fractures were the most common injuries, with an incidence of 0.6, 0.2, and 0.1 per 1000 children, respectively. The sex distribution was equal up to age 13 years; twice as many boys were seen at the age of 14 years. The majority of injuries occurred during sports. Forty-six patients (39%) had radiographs without a bony injury but with a serious injury confirmed on MRI. Seventy percent of the patients aged 9 to 14 years with traumatic knee hemarthrosis had a serious intra-articular injury that needed specific medical attention. Fifty-six percent of these patients had no visible injury on plain radiographs. Physicians who treat this group of patients should consider MRI to establish the diagnosis when there is no or minimal radiographic findings. The most common serious knee injury was a lateral

  1. Intra-articular injection of dexketoprofen in rat knee joint: histopathologic assessment of cartilage & synovium.

    Science.gov (United States)

    Ekici, Aycan Guner; Akyol, Onat; Ekici, Murat; Sitilci, Tolga; Topacoglu, Hakan; Ozyuvaci, Emine

    2014-08-01

    Effective pain control following outpatient surgical procedures is an important aspect of patient discharge. This study was carried out with an aim to investigate the histopathological effects of intra-articular dexketoprofen trometamol injection in knee joint on synovium and cartilage in an experimental rat model. In each of 40 rats, the right knee was designated as the study group and the left knee as the control group (NS group). Under aseptic conditions, 35 rats received an injection of 0.25 ml (6.25 mg) dexketoprofen trometamol into the right knee joint and an injection of 0.25 ml 0.9 per cent normal saline solution into the left knee joint. On the 1st, 2nd, 7th, 14th, and 21st days after intra-articular injection, rats in specified groups were sacrificed by intraperitoneal injection of 120 mg/kg sodium thiopental. Knee joints were separated and sectioned for histopathological examination. Inflammatory changes in the joints were recorded according to a grade scale. No significant difference in terms of pathological changes both in synovium and cartilage was observed between the NS group and the study group on days 1, 2, 7, 14 and 21 after intra-articular injection of dexketoprofen or saline in the knee joint. The findings showed no evidence of significant histopathological damage to the cartilage and synovia for a period up to 21 days following intra-articular administration of dexketoprofen trometamol in the knee joints of rats.

  2. The effectiveness of hyaluronic acid intra-articular injections in managing osteoarthritic knee pain

    Science.gov (United States)

    Anand, A

    2013-01-01

    Introduction Knee osteoarthritis (OA) is a common and progressive joint disease. Treatment options for knee OA vary from simple analgesia in mild cases to knee replacement for advanced disease. Knee pain due to moderate OA can be targeted with intra-articular injections. Steroid injections have been used widely in managing acute flare-ups of the disease. In recent years, viscosupplementation has been used as a therapeutic modality for the management of knee OA. The principle of viscosupplementation is based on the physiological properties of the hyaluronic acid (HA) in the synovial joint. Despite a sound principle and promising in vitro studies, clinical studies have been less conclusive on the effectiveness of HA in managing osteoarthritic knee pain. The aim of this systematic review was to assess the effectiveness of HA intra-articular injections in the management of osteoarthritic knee pain. Methods A systematic review of the literature was performed using MEDLINE®, Embase™ and CINAHL® (Cumulative Index to Nursing and Allied Health Literature). The databases were searched for randomised controlled trials available on the effectiveness of HA intra-articular injections in managing osteoarthritic knee pain. Results The search yielded 188 studies. Of these, 14 met the eligibility criteria and were reviewed in chronological order. Conclusions HA intra-articular injections have a modest effect on early to moderate knee OA. The effect peaks at around 6–8 weeks following administration, with a doubtful effect at 6 months. PMID:24165334

  3. Treatment of displaced intra-articular calcaneal fractures by ligamentotaxis: Current concepts' review

    NARCIS (Netherlands)

    T. Schepers (Tim); P. Patka (Peter)

    2009-01-01

    textabstractIntroduction: A large variety of therapeutic modalities for calcaneal fractures have been described in the literature. No single treatment modality for displaced intra-articular calcaneal fractures has proven superior over the other. This review describes and compares the different

  4. Treatment of displaced intra-articular calcaneal fractures by ligamentotaxis: current concepts' review

    NARCIS (Netherlands)

    Schepers, T.; Patka, P.

    2009-01-01

    A large variety of therapeutic modalities for calcaneal fractures have been described in the literature. No single treatment modality for displaced intra-articular calcaneal fractures has proven superior over the other. This review describes and compares the different percutaneous distractional

  5. Combined Intra-Articular and Intravenous Tranexamic Acid Reduces Blood Loss in Total Knee Arthroplasty

    DEFF Research Database (Denmark)

    Nielsen, Christian Skovgaard; Jans, Øivind; Ørsnes, Thue

    2016-01-01

    BACKGROUND: In total knee arthroplasty, both intravenous (IV) and intra-articular (IA) administration of tranexamic acid (TXA) have been shown to reduce blood loss in several randomized controlled trials, although routine use of systemic TXA is considerably more common. However, to our knowledge...

  6. A comparison of analgesic effect of intra-articular levobupivacaine with bupivacaine following knee arthroscopy

    International Nuclear Information System (INIS)

    Karaman, Yucel; Bor, Canan; Kayali, Cemil; Ozturk, Hasan; Kaya, Ahmet

    2009-01-01

    To compare the postoperative analgesic effects of intra-articular levobupivacaine with bupivacaine following knee arthroscopy. Forty patients, aged between 20-60 years and undergoing elective knee arthroscopy were enrolled into the study protocol that was carried out in Tepecik Education and Research Hospital, Izmir, Turkey between January and June 2007. General anesthesia protocol was the same in all patients. At the end of surgery, the patients were randomly assigned into 2 groups (n=20 in each group). Group L received 20 ml 0.5% levobupivacaine and Group B received 20 ml 0.5% bupivacaine intra-articularly. We evaluated the level of postoperative pain (by visual analoque scale at 1, 2, 4, 6, 12, and 24 hours after surgery), first analgesic requirement time (period measured from the end of the surgery until further analgesia was demanded), and total analgesic consumption during 24 hours. There were no significant difference in the postoperative pain scores of the patients between groups. The first analgesic requirement times were not statistically different. Twelve patients in Group L (60%) and 9 patients in Group B (45%) needed no additional analgesic during the 24 hours (p>0.05). No complications and side effects were found related to the intra-articular treatment. The results of the study show that intra-articular 20 ml 0.5% levobupivacaine provides effective analgesia comparable to that provided by 20 ml 0.5% bupivacaine. (author)

  7. Feasibility and efficacy of intraarticular steroids (IAS) in juvenile idiopathic arthritis (JIA).

    Science.gov (United States)

    Verma, Sumit; Gupta, Rajiva; Lodha, Rakesh; Kabra, S K

    2009-03-01

    Thirteen children with juvenile idiopathic arthritis (JIA) were treated with intraarticular steroid injection of triamcilone acetonide as a day care procedure. More than half (53.4%) the children were free of pain, limp and NSAID's use, with improvement in functional score at 12 weeks. No side effects were reported during the period of the study.

  8. Effectiveness of preemptive intra-articular levobupivacaine on pain relief after arthroscopic knee surgery

    Directory of Open Access Journals (Sweden)

    Seher Altinel

    2017-06-01

    Conclusion: Preemptive analgesia using intraarticular levobupivacaine 5 mg/ml (20 ml total volume provides better pain control-evaluated through VAS scoring, time to first analgesic request and opioid consumption - compared to saline in patients undergoing arthroscopic knee surgery. [Arch Clin Exp Surg 2017; 6(2.000: 91-95

  9. Ultrasound-guided intraarticular injection for MR arthrography of the shoulder

    International Nuclear Information System (INIS)

    Schaeffeler, Christoph; Bruegel, M.; Waldt, S.; Rummeny, E.J.; Woertler, K.

    2010-01-01

    Purpose: To evaluate ultrasound guidance for intraarticular contrast injection via an anterolateral approach in comparison with fluoroscopic guidance. Materials and Methods: Contrast agent injection was performed in 40 consecutive patients, 20 under sonographic guidance and 20 under fluoroscopic guidance. None of the patients had previous shoulder surgery. The procedure time was measured and the efficiency of joint distension, incidence of extravasation and intraarticular air on the consecutive MR arthrograms were assessed by three blinded radiologists with musculoskeletal radiology experience. Statistical analysis was performed using the Kruskal-Wallis test. Results: Intraarticular contrast injection was successfully accomplished in all 40 patients. Subsequent MR arthrograms did not show any significant difference between sonographic and fluoroscopic guidance with respect to diagnostic quality, joint distension (p = 0.6665), intraarticular air bubbles (p = 0.1567) and occurrence of contrast extravasation (p = 0.8565). The mean duration of ultrasound-guided injection was 7:30 min compared to a shorter procedure time of 4:15 min for fluoroscopic guidance. In both groups, no procedural complications were observed. Conclusion: Ultrasound-guided injection for MR arthrography of the shoulder via an anterolateral approach represents a simple, safe, and effective technique which yields comparable results to those of injection under fluoroscopic guidance, but is slightly more time-consuming. (orig.)

  10. Accelerated avascular necrosis after single intra-articular injection of corticosteroid into the hip joint

    OpenAIRE

    Kassam, A M

    2010-01-01

    Avascular necrosis (AVN) involves destruction of the hip joint. Long-term use of steroids has been shown to cause AVN. This article presents a case of intra-articular injection of steroid causing a rapid onset of AVN in the hip joint. Bone histology at time of total hip replacement showed evidence of AVN and no evidence of infection.

  11. Intraarticular cortisone injection for osteoarthritis of the hip. Is it effective? Is it safe?

    Science.gov (United States)

    Kruse, David W

    2008-12-01

    Osteoarthritis of the hip is a significant source of morbidity in the elderly. Treatment guidelines are available for the management of hip osteoarthritis, but these do not address the application of intraarticular corticosteroid injection. The intraarticular injection of corticosteroid is used in the management of other large joint osteoarthritic diseases and is well studied in the knee, however, this data cannot be used to make sound clinical decisions regarding its use for hip osteoarthritis. There are also concerns regarding the safety of this modality. Review of the published literature reveals that there are eight trials examining the efficacy of intraarticular corticosteroid injection for hip osteoarthritis and of these only four are randomized controlled trials. In general, the available literature demonstrates a short-term reduction of pain with corticosteroid injection and is indicated for patients refractory to non-pharmacologic or analgesic and NSAID therapy. The use of radiologic-guidance is recommended and, with proper sterile technique, the risk of adverse outcomes is very low. Future randomized controlled trials are needed to further examine the efficacy and safety of intraarticular corticosteroid injection for hip osteoarthritis.

  12. Anestesia em paciente portador de distrofia muscular de Duchenne: relato de casos Anestesia en un paciente portador de distrofia muscular de Duchenne: relato de casos Anesthesia for Duchenne muscular dystrophy patients: case reports

    Directory of Open Access Journals (Sweden)

    Rodrigo Machado Saldanha

    2005-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Este estudo objetiva relatar dois casos de anestesia em pacientes portadores de Distrofia Muscular de Duchenne (DMD, uma doença rara, progressiva e incapacitante, e discutir sobre a conduta anestésica. O comprometimento das funções pulmonar e cardíaca, a possibilidade de ocorrência de hipertermia maligna, a maior sensibilidade aos bloqueadores neuromusculares e o aumento da morbidade pós-operatória são alguns dos desafios enfrentados pelo anestesiologista. RELATO DOS CASOS: O primeiro caso foi o de um paciente pediátrico com diagnóstico de DMD e rabdomiossarcoma, agendado para exérese da lesão e esvaziamento cervical ampliado. Na avaliação pré-anestésica (anamnese, exame clínico e exames complementares não foram detectadas alterações, exceto pela tumoração cervical. Optou-se pela técnica venosa total, com remifentanil em infusão contínua e propofol em infusão alvo-controlada, sem a utilização de bloqueadores neuromusculares. O procedimento cirúrgico teve duração de 180 minutos, sem intercorrências. O segundo caso foi de um paciente do sexo masculino, 24 anos, com diagnóstico de DMD e colelitíase com indicação cirúrgica, cuja avaliação pré-operatória revelou pneumopatia restritiva grave, com diminuições da capacidade e da reserva respiratórias, sendo necessário o uso de BIPAP nasal noturno. Neste paciente, optou-se pela intubação traqueal com sedação mínima e anestesia tópica, seguida pela técnica venosa total com remifentanil em infusão contínua e propofol em infusão alvo-controlada, sem a utilização de bloqueadores neuromusculares. Ao término, o paciente foi extubado ainda na sala de operações e imediatamente colocado no BIPAP nasal. Encaminhado à UTI, com alta no 2º PO e alta hospitalar no 3º PO. CONCLUSÕES: A anestesia venosa total com infusão contínua de propofol e remifentanil sem bloqueadores neuromusculares constitui-se em opção segura e

  13. Pharmacokinetics of triamcinolone acetonide following intramuscular and intra-articular administration to exercised Thoroughbred horses.

    Science.gov (United States)

    Knych, H K; Vidal, M A; Casbeer, H C; McKemie, D S

    2013-11-01

    The use of triamcinolone acetonide (TA) in performance horses necessitates establishing appropriate withdrawal times prior to performance. To describe the plasma pharmacokinetics of TA and time-related urine and synovial fluid concentrations following i.m. and intra-articular administration to exercised Thoroughbred horses. Block design. Twelve racing fit adult Thoroughbred horses received a single i.m. administration of TA (0.1 mg/kg bwt). After an appropriate washout period, the same horses then received a single intra-articular TA administration (9 mg) into the right antebrachiocarpal joint. Blood, urine and synovial fluid samples were collected prior to, and at various times, up to 60 days post drug administration and analysed using liquid chromatography-mass spectrometry. Plasma data were analysed using noncompartmental analysis. Maximum measured plasma TA concentrations were 0.996 ± 0.391 at 13.2 h and 1.27 ± 0.278 ng/ml at 6.5 h for i.m. and intra-articular administration, respectively. The plasma terminal elimination half-life was 11.4 ± 6.53 and 0.78 ± 1.00 days for i.m. and intra-articular administration, respectively. Following i.m. administration, TA was below the limit of detection (LOD) by Days 52 and 60 in plasma and urine, respectively. Following intra-articular administration TA was undetectable by Day 7 in plasma and Day 8 in urine. Triamcinolone acetonide was also undetectable in any of the joints sampled following i.m. administration and remained above the limit of quantitation (LOQ) for 21 days following intra-articular administration. This study extends previous studies describing the pharmacokinetics of TA following i.m. and intra-articular administration to the horse and suggests that plasma and urine concentrations are not a good indicator of synovial fluid concentrations. Furthermore, results of this study supports an extended withdrawal time for TA given i.m. © 2013 EVJ Ltd.

  14. Anestesia congênita de córnea associada à anestesia de ramo do trigêmio: relato de caso Congenital corneal anesthesia related to trigeminal anesthesia: case report

    Directory of Open Access Journals (Sweden)

    Miguel José Calix Netto

    2005-12-01

    Full Text Available A anestesia corneana por ser uma condição rara, freqüentemente é confundida ou não diagnosticada durante o exame de rotina do segmento anterior. Relato de caso de um paciente de 18 anos encaminhado ao ambulatório de córnea e doenças externas com quadro clinico de síndrome de olho seco e com diagnóstico provável de síndrome de Sjögren. Era amblíope de olho direito devido à opacidade corneana no eixo visual secundária a trauma com unha na infância. Foi pesquisada sensibilidade corneana que era ausente em ambos os olhos; olho seco grave e com BUT (tempo de quebra do filme lacrimal menor que 4 segundos. Foi feito diagnóstico de anestesia corneana congênita associada a hipoestesia do nervo trigêmio pela avaliação neurológica da sensibilidade facial e movimentos bruscos do queixo que evidenciavam alterações sensoriais do nervo. O oftalmologista geral e principalmente o especialista em segmento anterior devem ter como rotina a pesquisa da sensibilidade corneana no exame do segmento anterior.Corneal anesthesia is a rare condition, therefore its diagnosis is frequently impaired or it is not noticed during the anterior segment examination. Case report of a 18-year-old patient referred to our Corneal and External Disease Department who complained of dry eye symptoms and with a suspicion of Sjögren's syndrome. She had amblyopia of the right eye, consequence of corneal leucoma over the visual axis secondary to a fingernail traumatism inflicted by herself in childhood. On the ophthalmologic examination corneal sensitivity was absent in both eyes. Severe dry eye and breakup time less than four seconds. Diagnosis of congenital corneal anesthesia was established, secondary to trigeminal anesthesia found on neurological evaluation of facial sensitivity. She also showed sudden movements of the chin which evidenced sensorial pathology of the trigeminal nerve. The general ophthalmologist and specially anterior segment specialists must

  15. Concentração plasmática de ropivacaína durante anestesia peridural lombar em crianças

    Directory of Open Access Journals (Sweden)

    Verônica Vieira da Costa

    2002-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A ropivacaína é o mais novo anestésico local de uso na prática clínica. Sua estrutura é semelhante a forma levógira da bupivacaína, tendo portanto baixa toxicidade. Os valores das concentrações plasmáticas que podem ser atingidos em crianças, com o uso desta droga e também da bupivacaína (mesmo a forma racêmica administradas por via peridural lombar, são ainda pouco conhecidos. O objetivo desse estudo foi avaliar as concentrações sangüíneas de ropivacaína e bupivacaína por via peridural lombar em crianças, em bloqueios eficientes, relacionando-as aos valores descritos como níveis plasmáticos seguros. MÉTODO: Oitenta e um pacientes de ambos os sexos, submetidos à cirurgia de membros inferiores, receberam aleatoriamente ropivacaína (n = 41 ou bupivacaína (n = 40 por via peridural lombar associado à anestesia geral. Foram coletadas oito amostras de sangue venoso nos intervalos de tempo: zero (controle, 5, 25, 40, 60, 120, 180 e 240 minutos, e através de cromatografia de gás foram dosadas as concentrações plasmáticas da ropivacaína e da bupivacaína. RESULTADOS: Não houve diferença estatisticamente significante com relação aos dados antropométricos e variáveis fisiológicas estudadas entre os pacientes que receberam ropivacaína e bupivacaína. As doses médias administradas de ropivacaína e bupivacaína foram 2,35 mg.kg-1 e 2,13 mg.kg-1, respectivamente, que geraram as concentrações plasmáticas de 2,334 µg.ml-1 e 1,111 µg.ml-1, aos 25 e 40 minutos. Ambas abaixo do nível considerado seguro (3 µg.kg-1. CONCLUSÕES: A administração peridural lombar de ropivacaína e bupivacaína em crianças, nas doses abaixo de 3 mg.kg-1, produz bloqueio anestésico eficaz e determina concentrações plasmáticas que podem ser consideradas seguras.

  16. Micro- and Nano-Carrier Mediated Intra-Articular Drug Delivery Systems for the Treatment of Osteoarthritis

    International Nuclear Information System (INIS)

    Zhang, Z.; Huang, G.

    2012-01-01

    The objective of this paper is to provide readers with current developments of intra-articular drug delivery systems. In recent years, although the search for a clinically successful ideal carrier is ongoing, sustained-release systems, such as polymeric micro- and nanoparticles, liposomes, and hydrogels, are being extensively studied for intra-articular drug delivery purposes. The advantages associated with long-acting preparations include a longer effect of the drug in the action site and a reduced risk of infection due to numerous injections consequently. This paper discusses the recent developments in the field of intra-articular sustained-release delivery systems for the treatment of osteoarthritis

  17. Micro- and Nano-Carrier Mediated Intra-Articular Drug Delivery Systems for the Treatment of Osteoarthritis

    Directory of Open Access Journals (Sweden)

    Zhiyue Zhang

    2012-01-01

    Full Text Available The objective of this paper is to provide readers with current developments of intra-articular drug delivery systems. In recent years, although the search for a clinically successful ideal carrier is ongoing, sustained-release systems, such as polymeric micro- and nanoparticles, liposomes, and hydrogels, are being extensively studied for intra-articular drug delivery purposes. The advantages associated with long-acting preparations include a longer effect of the drug in the action site and a reduced risk of infection due to numerous injections consequently. This paper discusses the recent developments in the field of intra-articular sustained-release delivery systems for the treatment of osteoarthritis.

  18. A Case Report of Intra-articular Bee Venom Pharmacopuncture for Partial Tear of Triangular Fibrocartilage Complex

    Directory of Open Access Journals (Sweden)

    Lee, Kwangho

    2009-12-01

    Full Text Available Objective: This case was to report a case of Partial Tear of Triangular Fibrocartilage Complex treated by Intra-articular bee venom Pharmacopuncture. Methods: The patient was treated by Intra-articular bee venom Pharmacopuncture. The Effect of Treatment was evaluated by Visual Analog Scale(VAS and Modified Mayo Wrist Score(Wrist Score. Results & Conclusions: After Treatment, Patient's VAS decreased and Wrist Score increased. For this results, Intra-articular Bee Venom Pharmacopuncture may be effective for Partial Tear of Triangular Fibrocartilage Complex.

  19. Bupivacaína racêmica, levobupivacaína e ropivacaína em anestesia loco-regional para oftalmologia: um estudo comparativo Racemic bupivacaine, levobupi vacaine and ropivacaine in regional anesthesia for ophtalmology: a comparative study

    Directory of Open Access Journals (Sweden)

    Edno Magalhães

    2004-04-01

    Full Text Available OBJETIVO: A bupivacaína racêmica, utilizada largamente em anestesia peribulbar devido à boa qualidade de bloqueio motor, apresenta menor margem de segurança para cardiotoxicidade em relação a ropivacaína e bupivacaína levógira. O objetivo deste estudo foi comparar o grau de bloqueio motor e alteração da pressão intra-ocular (PIO em anestesia peribulbar produzida pela bupivacaína racêmica, levobupivacaína e ropivacaína. MÉTODOS: Noventa e sete pacientes, estado físico I e II da classificação da Sociedade Americana de Anestesiologistas, submetidos a anestesia peribulbar, foram divididos em três grupos: grupo A-(n=16 bupivacaína racêmica 0,75% com adrenalina 1:200.000; grupo B -(n=16 bupivacaína levógira 0,75% com adrenalina 1:200.000; grupo C -(n=15 ropivacaína 0,75%. Utilizou-se 7ml da solução anestésica com 280 UI de hialuronidase, em punção única no rebordo orbital inferior. Foram registrados a PIO e grau de bloqueio motor 5 minutos antes da punção e 1, 2, 3, 4, 5 e 10 minutos após a punção. O bloqueio motor foi avaliado pela escala de Nicoll. Para a análise estatística, foram utilizados os testes de Wilcoxon, análise de freqüência simples e t de Student. Foi considerado significativo pBACKGROUND AND OBJECTIVE: Racemic bupivacaine, used in peribulbar anesthesia owing to its high potential to promote motor blockade, presents a smaller safety margin for cardiotoxicity in relation to ropivacaine and levobupivacaine. The objective of this study was to compare the degree of motor blockade and alteration of intraocular pressure (IOP produced by racemic bupivacaine, levobupivacaine and ropivacaine in peribulbar block. METHOD: Ninety seven patients, ASA physical status I and II, submitted to peribulbar anesthesia, were randomly allocated into three groups: group A-(n=16 receiving racemic bupivacaine 0.75% with epinephrine 1:200.000; group B -(n=16 levobupivacaine 0.75% with epinephrine 1:200.000; group C -(n=15

  20. The Effect of Intra-articular Cocktail Versus Femoral Nerve Block for Patients Undergoing Hip Arthroscopy.

    Science.gov (United States)

    Childs, Sean; Pyne, Sonia; Nandra, Kiritpaul; Bakhsh, Wajeeh; Mustafa, S Atif; Giordano, Brian D

    2017-12-01

    To compare clinical efficacy and complication rate as measured by postoperative falls and development of peripheral neuritis between intra-articular blockade and femoral nerve block in patients undergoing arthroscopic hip surgery. An institutional review board approved retrospective review was conducted on a consecutive series of patients who underwent elective arthroscopic hip surgery by a single surgeon, between November 2013 and April 2015. Subjects were stratified into 2 groups: patients who received a preoperative femoral nerve block for perioperative pain control, and patients who received an intra-articular "cocktail" injection postoperatively. Demographic data, perioperative pain scores, narcotic consumption, incidence of falls, and iatrogenic peripheral neuritis were collected for analysis. Postoperative data were then collected at routine clinical visits. A total of 193 patients were included in this study (65 males, 125 females). Of them, 105 patients received preoperative femoral nerve blocks and 88 patients received an intraoperative intra-articular "cocktail." There were no significant differences in patient demographics, history of chronic pain (P = .35), worker's compensation (P = .24), preoperative pain scores (P = .69), or intraoperative doses of narcotics (P = .40). Patients who received preoperative femoral nerve blocks reported decreased pain during their time in PACU (P = .0001) and on hospital discharge (P = .28); however, there were no statistically significant differences in patient-reported pain scores at postoperative weeks 1 (P = .34), 3 (P = .64), and 6 (P = .70). Administration of an intra-articular block was associated with a significant reduction in the rate of postoperative falls (P = .009) and iatrogenic peripheral neuritis (P = .0001). Preoperative femoral nerve blocks are associated with decreased immediate postoperative pain, whereas intraoperative intra-articular anesthetic injections provide effective postoperative

  1. Anestesia regional y saturación de oxígeno posoperatorio en el paciente geriátrico

    Directory of Open Access Journals (Sweden)

    Alfonso R León

    2001-06-01

    Full Text Available Numerosos estudios plantean la necesidad de suministrar oxígeno suplementario a pacientes geriátricos en el período posoperatorio (PO, después de anestesia regional como profilaxis de hipoxemia. Teniendo en cuenta lo anterior, se decidió comprobar cómo se comporta la saturación de oxígeno (STO2 en el PO en los pacientes geriátricos que se asistieron con el uso de esta técnica. Previa autorización del consejo científico se seleccionaron al azar 50 pacientes ASA I-II-II (F = 30, K = 20 intervenidos de hemiabdomen inferior y miembros inferiores. Preoperatoriamente se registraron variables demográficas, antecedentes patológicos personales (APP y (STO2. Se realizó anestesia subaracnoidea (SA o peridural (PE. En el PO se realizaron 6 mediciones de la STO2 (cada 10 min durante 1 h a la salida del salón de operaciones. Se procesaron estadísticamente los resultados (comparación de medias. Edad promedio 76 ± 6 años, anestesia PE 20, SA 30, Hb media 10,5 g/L STO2 preoperatorio 94 % ± 1,5. Mediciones en el PO 1ra. 95 % ± 1,8; 2da. 94 % ± 1,3; 3ra. 93 % ± 2,1; 4ta. 95 % ± 1,9; 5ta. 94 % ± 1,5; 6ta. 93 % ± 1,7. No se hallaron diferencias estadísticamente significativas entre estas mediciones, ni en relación con la SOT2 preoperatorias con el uso de esta técnica anestésica en la población geriátricaMany studies state the need to administer supplementary oxygen to elderly patients in the postoperative period (POP after regional anesthesia as a prophylaxis of hipoxemia. Bearing in mind the above mentioned, we decided to confirm the behaviour of oxygen saturation (O2S in the POP of these aged patients that were assisted with this technique. Having cosulted the Scientifc Council, we proceed to a random selection of 50 ASA I-II-III patients (F = 30, K = 20 that underwent an operation of inferior hemiabdomen and lower limbs. Demographic variables, personal pathologic histories (PPH and 02S were obtained before the operation

  2. Relato de caso: anestesia em paciente portador de distrofia torácica asfixiante: Síndrome de Jeune

    Directory of Open Access Journals (Sweden)

    Deise Saletti

    2012-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Síndrome de Jeune, ou Distrofia Torácica Asfixiante, é uma doença autossômica recessiva. Esta síndrome é caracterizada por uma displasia óssea com variadas anormalidades: torácica, pancreática, cardíaca, hepática, renal e da retina. A idade em que o quadro clínico dos pacientes se apresenta está correlacionada com a gravidade da doença. Esses pacientes apresentam policondrodistrofia com costelas largas, curtas, horizontais e junções costocondrais irregulares levando a uma caixa torácica rígida e reduzida com grau de injúria respiratória variado. RELATO DO CASO: Paciente do sexo masculino, 4 meses, 7 kg, portador de Distrofia Torácica Asfixiante. Apresentava-se intubado e com caixa torácica reduzida. Ecocardiograma: hipertensão pulmonar leve. Tomografia de tórax: hipoplasia pulmonar. Submetido à toracoplastia bilateral e toracotomia sob anestesia geral. Manutenção da anestesia: infusão contínua de sufentanil e sevoflurano. Parâmetros ventilatórios: ventilação mecânica ciclada à pressão. Com a abertura do tórax, houve melhora dos parâmetros ventilatórios e, após o posicionamento da prótese torácica, observou-se limitação ventilatória. Decidiu-se pela diminuição da prótese torácica com consequente melhora da ventilação. CONCLUSÕES: É imprescindível o diagnóstico de todas as anormalidades presentes para o correto manejo anestésico. Foi necessária observação para adequar ventilação pré- e pós-toracotomia/toracoplastia e para manter o paciente hemodinamicamente estável. A forma mais adequada para ventilação mecânica é a ciclada à pressão para vencer a barreira mecânica. No intraoperatório, é desejável manter o pico de pressão inspiratória o mais baixo possível para minimizar o risco de barotrauma, de impedimento do retorno venoso e diminuição do débito cardíaco.

  3. Anestesia na população negra Anestesia en la población negra Anesthesia in the afro-american population

    Directory of Open Access Journals (Sweden)

    Nilton Bezerra do Vale

    2003-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Percentual significativo dos 12 milhões de negros americanos pode apresentar modificações fisiológicas, fisiopatológicas e farmacológicas capazes de modificar o bom desenvolvimento do ato anestésico; a população brasileira que se considera afro-descendente (40% pode também apresentá-las por causa da mesma origem étnica e geográfica. O objetivo desta revisão é reavaliar o viés da diferença racial em eventuais mudanças no efeito das drogas anestésicas e adjuvantes no ato anestésico. CONTEÚDO: A análise dos estudos fisiopatológicos inerentes à histórica migração do gene africano em relação aos caucasianos mostra significativas diferenças raciais entre o negro americano ou africano, sugerindo uma estreita interface entre a genética e o ambiente, capaz de modificar o procedimento anestésico. As condições sócio-econômicas desfavoráveis da população negra das Américas como resultado de 400 anos de história de escravidão continuam sempre a influenciar na preservação de diferenças culturais e fisiológicas, além da cor da pele: disfunções de sistemas orgânicos estão relacionados com o SNC, SCV, respiratório e renal. No entanto, modificações de efeito de drogas anestésicas e seus adjuvantes, como diminuição do efeito analgésico local do creme anestésico EMLA, aumento do efeito hipnótico do propofol e da toxicidade do paracetamol, menor efeito anti-hipertensivo das drogas que reduzem renina (IECA, bloqueadores beta2 e de AT1, menor ação dos vasodilatadores beta2 e menor fibrinólise do t-PA podem afetar a conduta pré e pós-anestésica, sobretudo em pacientes negros hipertensos, renais, asmáticos ou com acidente vascular cerebral. CONCLUSÕES: Resposta a drogas pode variar entre diferentes populações devido a fatores biológicos (idade, sexo, doença, genéticos, culturais e ambientais. O fator demográfico raça deve ser valorizado na visita ou consulta pr

  4. Topografia do cone medular da irara (Eira barbara e sua relevância em anestesias epidurais

    Directory of Open Access Journals (Sweden)

    Érika Branco

    2013-06-01

    Full Text Available Encontrada principalmente na América do Sul, a irara é um carnívoro pertencente à família Mustelidae, a qual pouco se tem informações sobre sua morfologia de forma geral. Diante disso, objetivou-se conhecer melhor parte do sistema nervoso desta espécie, mais precisamente a topografia do cone medular, a fim de subsidiar intervenções anestésicas peridurais nesta, uma vez que a clínica de animais selvagens vem crescendo a cada dia. Foram estudados três exemplares machos, adultos, provenientes da área de Mina Bauxita, Paragominas, doados ao Laboratório de Pesquisa Morfológica Animal (LaPMA, Universidade Federal Rural da Amazônia (UFRA, Belém, os quais foram radiografados e dissecados ao nível lombossacral, seguido de exposição do cone medular. Este, por sua vez, situou-se entre L4-L6 possuindo comprimento médio de 4,31cm, o que nos levou a sugerir a região sacrococcígea como ponde ideal para prática de anestesias epidurais nesta espécie.

  5. Anestesia para cesariana em paciente com síndrome de Guillain-Barré: relato de caso

    Directory of Open Access Journals (Sweden)

    Daniel Volquind

    2013-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A Síndrome de Guillain-Barré durante a gestação é considerada uma CIRURGIA, Cesárea; complicação neurológica rara e o manejo anestésico para a cesariana nessas pacientes ainda não é consenso na literatura. O objetivo deste artigo é relatar o caso de uma paciente gestante portadora da Síndrome de Guillain-Barré submetida à cesariana. RELATO DO CASO: Paciente feminina, 22 anos, com 35 semanas e cinco dias de idade gestacional, da celularidade. A técnica anestésica empregada foi a anestesia geral, induzida com propofol 1,5 mg.kg-1 e mantida com sevofiurano 2% em oxigênio e fentanil 3 µg.kg-1. O procedimento transcorreu sem complicações, tanto para a gestante quanto para o concepto. A paciente obteve alta no décimo dia de internação, após melhora progressiva do quadro neurológico. CONCLUSÕES: A técnica anestésica a ser empregada em gestantes portadoras da Síndrome de Guillain-Barré que necessitam fazer cesariana permanece como escolha do anestesiologista, que deve ser guiado pelo quadro clínico e pelas comorbidades de cada paciente.

  6. Hiperpotassemia pela solução Euro-Collins na anestesia para transplante renal: relato de caso

    Directory of Open Access Journals (Sweden)

    Eunice Sizue Hirata

    2013-10-01

    Full Text Available OBJETIVOS: Descrever uma anestesia para transplante renal que se complicou com a elevação brusca de potássio, pela reperfusão do rim com solução Euro-Collins no campo operatório. Também será relatado o diagnóstico e o tratamento empregados nessa complicação. CONCLUSÃO: O uso de soluções de perfusão no campo cirúrgico requer cuidados na monitoração, como eletrocardioscopia e dosagem de potássio sérico, e disponibilidade para uso imediato de gluconato de cálcio, insulina e salbutamol. A substituição da solução Euro-Collins por soro fisiológico imediatamente antes do implante pode ser uma opção útil em pacientes com níveis de potássio sabidamente elevados.

  7. Anestesia peridural torácica para cirurgia plástica de mama em paciente portadora de miastenia gravis: relato de caso Anestesia peridural torácica para cirugía plástica de mama en paciente portadora de miastenia gravis: relato de caso Thoracic epidural anesthesia for mammaplasty in myasthenia gravis patient: case report

    Directory of Open Access Journals (Sweden)

    Fabiano Timbó Barbosa

    2005-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A miastenia gravis é uma doença crônica, auto-imune, caracterizada pela fraqueza da musculatura esquelética em decorrência da diminuição dos receptores de acetilcolina na junção neuromuscular. O objetivo deste relato é mostrar um caso de paciente com miastenia gravis submetida a anestesia peridural torácica para cirurgia plástica de mama. RELATO DO CASO: Paciente com 51 anos, portadora de miastenia gravis foi submetida a anestesia peridural torácica com bupivacaína e fentanil. Não houve sinais de depressão respiratória. A paciente recebeu alta hospitalar após 36 horas. CONCLUSÕES: O presente caso sugere como conduta anestésica para o paciente portador de miastenia gravis a anestesia peridural como técnica única, sem a obrigatoriedade de intubação orotraqueal.JUSTIFICATIVA Y OBJETIVOS: La miastenia gravis es una enfermedad crónica, auto-inmune, caracterizada por la debilidad de la musculatura esquelética resultante de la disminución de los receptores de acetilcolina en la unión neuromuscular. El objetivo de este relato es mostrar el caso de una paciente con miastenia gravis sometida a anestesia peridural torácica para una cirugía plástica de mama. RELATO DEL CASO: Paciente del sexo femenino, 51 años, portadora de miastenia gravis fue sometida a anestesia peridural torácica con bupivacaína y fentanil. No hubo señales de depresión respiratoria. La paciente recibió alta hospitalaria después de 36 horas. CONCLUSIONES: Este actual caso sugiere como conducta anestésica para el paciente portador de miastenia gravis la anestesia peridural como única técnica, sin la obligatoriedad de intubación orotraqueal.BACKGROUND AND OBJECTIVES: Myasthenia gravis is a chronic autoimmune disease characterized by skeletal muscles weakness promoted by decreased acetylcholine receptors in the neuromuscular junction. This report aimed at describing a case of myasthenia gravis patient submitted to thoracic

  8. Intra-articular decorin influences the fibrosis genetic expression profile in a rabbit model of joint contracture.

    Science.gov (United States)

    Abdel, M P; Morrey, M E; Barlow, J D; Grill, D E; Kolbert, C P; An, K N; Steinmann, S P; Morrey, B F; Sanchez-Sotelo, J

    2014-01-01

    The goal of this study was to determine whether intra-articular administration of the potentially anti-fibrotic agent decorin influences the expression of genes involved in the fibrotic cascade, and ultimately leads to less contracture, in an animal model. A total of 18 rabbits underwent an operation on their right knees to form contractures. Six limbs in group 1 received four intra-articular injections of decorin; six limbs in group 2 received four intra-articular injections of bovine serum albumin (BSA) over eight days; six limbs in group 3 received no injections. The contracted limbs of rabbits in group 1 were biomechanically and genetically compared with the contracted limbs of rabbits in groups 2 and 3, with the use of a calibrated joint measuring device and custom microarray, respectively. There was no statistical difference in the flexion contracture angles between those limbs that received intra-articular decorin versus those that received intra-articular BSA (66° vs 69°; p = 0.41). Likewise, there was no statistical difference between those limbs that received intra-articular decorin versus those who had no injection (66° vs 72°; p = 0.27). When compared with BSA, decorin led to a statistically significant increase in the mRNA expression of 12 genes (p Cite this article: Bone Joint Res 2014;3:82-8.

  9. the use of hydrocortisone by local and intra-articular injection in a ...

    African Journals Online (AJOL)

    this reservoir or depot effect enhances its anti-inflamma- tory potency above that of ..... exposure or-the extensor muscle origins at the lateral epicondyle, a hard ... It is difficult to determine whether hydrocortisone or the mere puncture of the.

  10. Distraction of facets with intraarticular spacers as treatment for lumbar canal stenosis: report on a preliminary experience with 21 cases.

    Science.gov (United States)

    Goel, Atul; Shah, Abhidha; Jadhav, Madan; Nama, Santhosh

    2013-12-01

    The authors report their experience in treating 21 patients by using a novel form of treatment of lumbar degenerative disease that leads to canal stenosis. The surgery involved distraction of the facets using specially designed Goel intraarticular spacers and was aimed at arthrodesis of the spinal segment in a distracted position. The operation is based on the premise that subtle and longstanding facet instability, joint space reduction, and subsequent facet override had a profound and primary influence in the pathogenesis of degenerative lumbar canal stenosis. The surgical technique and the rationale for treatment are discussed. Between April 2006 and January 2011, 21 cases of lumbar degenerative disease resulting in characteristic lumbar canal stenosis were treated in the authors' department with the proposed technique. The patients were prospectively analyzed. There were 15 men and 6 women who ranged in age from 48 to 71 years (mean 58 years). Nine patients underwent 1-level and 12 patients underwent 2-level treatment. Surgery involved wide opening of the articular joint, denuding of the articular capsule/endplate cartilage, distraction of the facets, and forced impaction of Goel intraarticular spacers. Bone graft pieces obtained by sectioning the spinous processes were placed within and over the joint and in the midline over the adequately prepared host area of laminae. The Oswestry Disability Index and visual analog scale were used to clinically assess the patients before and after surgery and at follow-up. The alterations in the physical architecture of spinal canal and intervertebral foramen dimensions were evaluated before and after placement of the intrafacet implant and after at least 6 months of follow-up. All patients had varying degrees of relief from symptoms of local back pain and radiculopathy. Impaction of spacers within the facet joints resulted in an increase in the spinal canal and intervertebral root canal dimensions (mean 2.33 mm), reduction

  11. Promising Effect Of Intraarticular Ropivacaine In Femoral Neck Fractures Treated With Internal Fixation (Best Poster Award)

    DEFF Research Database (Denmark)

    Bech, Rune Dueholm

    2008-01-01

     Promising Effect Of Intraarticular Ropivacaine In Femoral Neck Fractures Treated With Internal Fixation Rune Bech*, Jens Lauritsen*+,Tine Dimon*, Ole Ovesen*, Claus Emmeluth, Søren Overgaard*. *:Dept. Ortopaedic Surgery, Odense University Hospital, +:Institute of Public Health-dept. biostatistics...... underwent osteosynthesis with 2 canulated hip screws and were prescribed regular paracetamol and supplementary opioid rescue analgesia as necessary. Pilot group: 11 patients received one peroperative (30 mL=100 mg) and 6 postoperative bolus installations  (10 mL=100 mg) of open label Ropivacaine through......-74) (p=0.012).   CONCLUSION This pilot-study suggests that intraarticular application of Ropivacaine may reduce opioid requirement after osteosynthesis of femoral neck fracture. However, this is an open pilot study with few patients. We find the results promising and have initiated a double...

  12. Low-Cost Intra-Articular Distraction Technique Using Kirschner Wires and a Toothed Lamina Spreader.

    Science.gov (United States)

    Shymon, Stephen Joseph; Harris, Thomas Gregory

    We describe a low-cost (instrument cost) technique for joint distraction using 2 Kirschner wires and a toothed lamina spreader in lieu of a Hintermann distractor. The described technique allows for temporary intra-articular distraction and visualization and preservation of the articular surface with extra-articular instrumentation. The technique can also allow for closed reduction and percutaneous treatment in cases of soft tissue compromise. Additionally, the technique uses common orthopedic surgical instruments, leading to a minimal learning curve for novice surgeons. We have found this distraction technique to be most effective for intra-articular preparation of hindfoot and midfoot arthrodeses and for navicular fracture reduction. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  13. Large Intra-Articular Anterior Cruciate Ligament Ganglion Cyst, Presenting with Inability to Flex the Knee

    Directory of Open Access Journals (Sweden)

    Jake Sloane

    2010-01-01

    Full Text Available A 41-year-old female presented with a 3-month history of gradually worsening anterior knee pain, swelling and inability to flex the knee. Magnetic resonance imaging (MRI revealed a large intra-articular cystic swelling anterior to the anterior cruciate ligament (ACL, extending into the Hoffa's infrapatellar fat pad. Following manipulation under anaesthesia and arthroscopic debridement of the cyst, the patient's symptoms were relieved with restoration of normal knee motion. ACL ganglion cysts are uncommon intra-articular pathological entities, which are usually asymptomatic and diagnosed incidentally by MRI. This is the first reported case of an ACL cyst being so large as to cause a mechanical block to knee flexion.

  14. Anestesia em paciente portadora de doença de moyamoya: relato de caso Anestesia en paciente portadora de enfermedad de moyamoya: relato de caso Anesthesia in patient with moyamoya disease: case report

    Directory of Open Access Journals (Sweden)

    Adriano Bechara de Souza Hobaika

    2005-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A doença de moyamoya é uma vasculopatia cerebral progressiva rara, mais freqüentemente diagnosticada em populações asiáticas, mas que também vem sendo identificada no Brasil. Durante a sua vida, pacientes portadores desta doença podem ser submetidos aos mais variados tipos de procedimentos cirúrgicos. O anestesiologista deve entender a fisiopatologia da doença e instituir as medidas peri-operatórias mais adequadas, no intuito de melhorar o prognóstico destes pacientes. RELATO DO CASO: Paciente do sexo feminino, 22 anos, com insuficiência renal crônica, portadora da doença de moyamoya, submetida à intervenção cirúrgica para instalação de fístula arteriovenosa. A anestesia foi induzida com fentanil, propofol e atracúrio e mantida com sevoflurano. Durante o procedimento, a paciente foi mantida em normocapnia e normotermia. A extubação foi realizada e a paciente transferida à sala de recuperação pós-anestésica sem complicações. CONCLUSÕES: Este artigo apresenta os cuidados anestésicos dispensados a uma paciente portadora da doença de moyamoya.JUSTIFICATIVA Y OBJETIVOS: La enfermedad de moyamoya es una vasculopatia cerebral progresiva rara, más frecuentemente diagnosticada en individuos asiáticos, y que también viene siendo identificada en Brasil. Durante su vida, pacientes portadores de esta enfermedad pueden ser sometidos a los más variados tipos de procedimientos quirúrgicos. El anestesiologista debe entender la fisiopatología de la enfermedad e instituir las medidas peri-operatorias más adecuadas, en el designio de mejorar el pronóstico de estos enfermos. RELATO DEL CASO: Paciente del sexo femenino, 22 años, insuficiencia renal crónica, portadora de la enfermedad de moyamoya, sometida a intervención quirúrgica para la instalación de fístula arteriovenosa. La anestesia fue inducida con fentanil, propofol y atracúrio y mantenida con sevoflurano. Durante el procedimiento

  15. Effectiveness of fluoroscopy-guided intra-articular steroid injection for hip osteoarthritis

    International Nuclear Information System (INIS)

    Subedi, N.; Chew, N.S.; Chandramohan, M.; Scally, A.J.; Groves, C.

    2015-01-01

    Aim: To demonstrate the benefits of fluoroscopy-guided intra-articular steroid injection in the hip with varying degrees of disease severity, and to investigate the financial aspects of the procedure and impact on waiting time. Materials and methods: A prospective study was undertaken of patients who underwent fluoroscopic intra-articular steroid injection over the 9-month study period. Comparative analysis of the Oxford hip pain score pre- and 6–8 weeks post-intra-articular injection was performed. Hip radiographs of all patients were categorised as normal, mild, moderate, or severe disease (four categories) based on the modified Kellgren–Lawrence severity scale, and improvement on the Oxford hip pain score on each of these four severity categories were assessed. Results: Within the study cohort of 100 patients, the mean increase in post-procedure hip score of 7.32 points confirms statistically significant benefits of the therapy (p<0.001, 95% confidence interval: 5.55–9.09). There was no significant difference in pre-injection hip score or change in score between the four severity categories (p=0.51). Significant improvement in hip score (p<0.05) was demonstrated in each of the four severity categories 6–8 weeks post-injection. No associated complications were observed. Conclusion: The present study confirms that fluoroscopy-guided intra-articular steroid injection is a highly effective therapeutic measure for hip osteoarthritis across all grades of disease severity with significant cost savings and the potential to reduce waiting times. - Highlights: • Comparable clinical effectiveness of fluoroscopy guided and theatre based therapeutic intra-articular hip injections. • Significant cost savings on fluoroscopy guided hip injection performed in a radiology department. • A potential reduction in patients' waiting time for the procedure.

  16. Intra-articular injection of dexketoprofen in rat knee joint : Histopathologic assessment of cartilage & synovium

    Directory of Open Access Journals (Sweden)

    Aycan Guner Ekici

    2014-01-01

    Full Text Available Background & objectives: Effective pain control following outpatient surgical procedures is an important aspect of patient discharge. This study was carried out with an aim to investigate the histopathological effects of intra-articular dexketoprofen trometamol injection in knee joint on synovium and cartilage in an experimental rat model. Methods: In each of 40 rats, the right knee was designated as the study group and the left knee as the control group (NS group. Under aseptic conditions, 35 rats received an injection of 0.25 ml (6.25 mg dexketoprofen trometamol into the right knee joint and an injection of 0.25 ml 0.9 per cent normal saline solution into the left knee joint. On the 1 st , 2 nd , 7 th , 14 th , and 21 st days after intra-articular injection, rats in specified groups were sacrificed by intraperitoneal injection of 120 mg/kg sodium thiopental. Knee joints were separated and sectioned for histopathological examination. Inflammatory changes in the joints were recorded according to a grade scale. Results: No significant difference in terms of pathological changes both in synovium and cartilage was observed between the NS group and the study group on days 1, 2, 7, 14 and 21 after intra-articular injection of dexketoprofen or saline in the knee joint. Interpretation & conclusions: The findings showed no evidence of significant histopathological damage to the cartilage and synovia for a period up to 21 days following intra-articular administration of dexketoprofen trometamol in the knee joints of rats.

  17. Intra-articular membranous interposition detected by MRI in developmental dysplasia of the hip

    Energy Technology Data Exchange (ETDEWEB)

    Watanabe, W.; Itoi, Eiji; Sato, Kozo [Akita Univ. (Japan). Dept. of Orthopedic Surgery

    2000-12-01

    Intra-articular membranous interposition was detected by MRI in the hip joint with residual subluxation of a girl aged 5 years 10 months. This structure, which had low signal intensity on both T1- and T2-weighted images, separated the femoral head from the acetabulum. Histological examination revealed chondrometaplasia, which suggested that this interposition might be transformed to a surface cartilaginous tissue of the secondary acetabulum often observed in residual subluxation of the hip. (orig.)

  18. Operative treatment of intra-articular calcaneal fractures with calcaneal plates and its complications

    Directory of Open Access Journals (Sweden)

    Rak Vaclav

    2009-01-01

    Full Text Available Background: In a retrospective study we analysed intra-articular calcaneal fracture treatment by comparing results and complications related to fracture stabilization with nonlocking calcaneal plates and locking compression plates. Materials and Methods: We performed 76 osteosynthesis (67 patients of intra-articular calcaneal fractures using the standard extended lateral approach from February 2004 to October 2007. Forty-two operations using nonlocking calcaneal plates (group A were performed during the first three years, and 34 calcaneal fractures were stabilized using locking compression plates (group B in 2007. In the Sanders type IV fractures, reconstruction of the calcaneal shape was attempted. Depending on the type of late complication, we performed subtalar arthroscopy in six cases, arthroscopically assisted subtalar distraction bone block arthrodesis in six cases, and plate removal with lateral-wall decompression in five cases. The patients were evaluated by the AOFAS Ankle-Hindfoot Scale. Results: Wound healing complications were 7/42 (17% in group A and 1/34 (3% in group B. No patient had deep osseous infection or foot rebound compartment syndrome. Preoperative size of Bφhler´s angle correlated with postoperative clinical results in both groups. There were no late complications necessitating corrective procedure or arthroscopy until December 2008 in Group B. All late complications ccurred in Group A. The overall results according to the AOFAS Ankle Hindfoot Scale were good or excellent in 23/42 (55% in group A and in 30/34 (85% in group B. Conclusion: Open reduction and internal fixation of intra-articular calcaneal fractures has become a standard surgical method. Fewer complications and better results related to treatment with locking compression plates confirmed in comparison to nonlocking ones were noted for all Sanders types of intra-articular calcaneal fractures. Age and Sanders type IV fractures are not considered to be the

  19. Incidence and treatment of intra-articular lesions associated with anterior cruciate ligament tears.

    Science.gov (United States)

    Todor, Adrian; Nistor, Dan; Buescu, Cristian; Pojar, Adina; Lucaciu, Dan

    2014-01-01

    The aim of the study is to retrospectively review the patients admitted and treated in the "Alexandru Rădulescu" Orthopedics and Traumatology Clinic, Cluj-Napoca for an anterior cruciate ligament tear over a 2-year period and document the intra-articular lesions found at arthroscopy as well as the treatment used for these associated lesions. The case records of 88 patients operated for anterior cruciate ligament tear over a period of 2 years were reviewed. There were 67 males and 21 females with a mean age of 28.9 years, ranging from 14 to 49 years. After recording the patient demographics, we documented all the intra-articular lesions found during knee arthroscopy, as well as all procedures undertaken concomitant with the ACL reconstruction. 50 of the 88 patients (56.8%) had associated intra-articular lesions at the time of anterior cruciate ligament reconstruction. The most common injury found was a meniscus tear, 48 patients (54.5%) had a meniscal pathology at the time of ligament reconstruction, medial meniscus being the most frequent injured one, found in 37 patients. Meniscectomy and meniscus suture were the procedures performed for these lesions, meniscectomy being more frequent. Chondral defects were the next associated injuries found with an incidence of 15.9% of the cases. The medial side of the knee was the most common site of chondral pathology. ACL tears are frequently associated with other intra-articular lesions, especially medial meniscus tears and chondral defects affecting the medial compartment. Such pathology most often needs surgical attention during the anterior cruciate ligament reconstruction.

  20. Intraarticular findings in the chronically painful shoulder. A study of 32 posttraumatic cases

    DEFF Research Database (Denmark)

    Suder, P.A.; Hougaard, K.; Frich, Lars Henrik

    1994-01-01

    the head activities. Symptoms of a "dead arm" and instability were also present. Patients with previous dislocations, traumas or radiographic signs of degenerative shoulder lesions were excluded. The patients had a decreased active range of motion and positive signs of apprehension and impingement......, arthroscopic labral resection and open subacromial decompression. In conclusion, patients with chronic posttraumatic shoulder pain have intraarticular injuries, especially tears of the glenoid labrum. History, clinical findings, radiography and sonography are seldom diagnostic. MRI is valuable, particularly...

  1. Anestesia para cirurgia ortopédica em criança com susceptibilidade à hipertermia maligna: relato de caso Anestesia para cirugía ortopédica en niño con susceptibilidad a la hipertermia maligna: relato de caso Anesthesia for orthopedic surgery in a child susceptible to malignant hyperthermia: case report

    Directory of Open Access Journals (Sweden)

    Renato Santiago Gomez

    2003-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Hipertermia maligna é uma miopatia autossômica dominante desencadeada por anestésicos inalatórios e bloqueadores neuromusculares, como halotano e succinilcolina, causando aumento da temperatura que pode ser fatal sem o tratamento imediato. O objetivo deste relato é descrever a conduta anestésica em uma criança susceptível à hipertermia maligna que foi submetida a procedimento cirúrgico ortopédico. RELATO DO CASO: Paciente do sexo feminino, com 3 anos, portadora de luxação congênita do quadril e susceptibilidade à hipertermia maligna, conforme história de anestesia anterior, foi submetida à correção cirúrgica ortopédica sob anestesia geral, com propofol e fentanil, associada à anestesia peridural lombar. A temperatura da paciente foi monitorizada continuamente durante a cirurgia e no período pós-operatório. A paciente apresentou recuperação pós-operatória sem intercorrências e recebeu alta hospitalar após cinco dias. CONCLUSÕES: A combinação de anestesia regional e venosa para o procedimento cirúrgico proposto em paciente com susceptibilidade à hipertermia maligna permitiu a condução anestésica com segurança.JUSTIFICATIVA Y OBJETIVOS: Hipertermia maligna es una miopatia autosómica dominante desencadenada por anestésicos inhalatorios y bloqueadores neuromusculares, como halotano y succinilcolina, causando aumento de la temperatura que puede ser fatal sin el tratamiento inmediato. El objetivo de este relato es describir la conducta anestésica en un niño susceptible a la hipertermia maligna que fue sometida a procedimiento quirúrgico ortopédico. RELATO DEL CASO: Niño, del sexo femenino, con 3 años, portadora de luxación congénita del cuadril (anca y susceptibilidad a la hipertermia maligna, conforme historia de anestesia anterior, fue sometida a la corrección quirúrgica ortopédica bajo anestesia general, con propofol y fentanil, asociada a anestesia peridural lumbar. La

  2. Intra-Articular Corticosteroids in Addition to Exercise for Reducing Pain Sensitivity in Knee Osteoarthritis

    DEFF Research Database (Denmark)

    Soriano-Maldonado, Alberto; Klokker, Louise; Bartholdy, Cecilie

    2016-01-01

    OBJECTIVE: To assess the effects of one intra-articular corticosteroid injection two weeks prior to an exercise-based intervention program for reducing pain sensitivity in patients with knee osteoarthritis (OA). DESIGN: Randomized, masked, parallel, placebo-controlled trial involving 100 particip......OBJECTIVE: To assess the effects of one intra-articular corticosteroid injection two weeks prior to an exercise-based intervention program for reducing pain sensitivity in patients with knee osteoarthritis (OA). DESIGN: Randomized, masked, parallel, placebo-controlled trial involving 100...... the injections all participants undertook a 12-week supervised exercise program. Main outcomes were changes from baseline in pressure-pain sensitivity (pressure-pain threshold [PPT] and temporal summation [TS]) assessed using cuff pressure algometry on the calf. These were exploratory outcomes from a randomized....... The mean group difference in changes from baseline at week 14 was 0.6 kPa (95% CI: -1.7 to 2.8; P = 0.626) for PPT and 384 mm×sec (95% CI: -2980 to 3750; P = 0.821) for TS. CONCLUSIONS: These results suggest that adding intra-articular corticosteroid injection 2 weeks prior to an exercise program does...

  3. Treatment of unstable intraarticular fracture of distal radius: POP casting with external fixation.

    Science.gov (United States)

    ur Rahman, Obaid; Khan, Mohammad Qadeem; Rasheed, Haroon; Ahmad, Saleem

    2012-04-01

    To compare radiological and functional outcome of external fixation and distraction with conservative Plaster of Paris (POP) cast for unstable intra-articular fractures of the distal radius. The study was conducted on 60 patients with unstable intra-articular fracture of distal radius who reported to emergency or outpatient Orthopaedic Surgery department of Benazir Bhutto Hospital, Rawalpindi, between March and August 2007. They were divided into two equal groups: Group A and Group B, treated by Plaster of Paris cast, and external fixation with distraction respectively. The functional outcome in terms of freedom from pain, range of movement, grip power and deformity, and the radiological outcome of radial length, incongruity and radio-ulnar joint position were analysed at three months follow-up using a 3-point scoring scale. In Group A, 1 (3%) patient showed excellent result, 8 (27%) patients good results, 19 (63%) patients fair results and 2 (7%) patients poor result. In Group B, 14 (47%) patients showed excellent results, 11 (37%) patients good results, 4 (13%) patients fair results and 1 (3%) patient poor result. The outcome score of the Group B patients was significantly better compared to the Group A patients (p value advantages over conventional Plaster of Paris cast in the treatment of unstable intra-articular fractures of distal radius.

  4. A new noninvasive controlled intra-articular ankle distraction technique on a cadaver model.

    Science.gov (United States)

    Aydin, Ahmet T; Ozcanli, Haluk; Soyuncu, Yetkin; Dabak, Tayyar K

    2006-08-01

    Effective joint distraction is crucial in arthroscopic ankle surgery. We describe an effective and controlled intra-articular ankle distraction technique that we have studied by means of a fresh-frozen cadaver model. Using a kyphoplasty balloon, which is currently used in spine surgery, we tried to achieve a controlled distraction. After the fixation of the cadaver model, standard anteromedial and anterolateral portals were used for ankle arthroscopy. From the same portals, the kyphoplasty balloon was inserted and placed in an appropriate position intra-articularly. The necessary amount of distraction was achieved by inflating the kyphoplasty balloon with a pressure regulation pump. All anatomic sites of the ankle joint were easily visualized with the arthroscope during surgery by changing the pressure and the intra-articular position of the kyphoplasty balloon. Ankle distraction was clearly seen on the arthroscopic and image intensifier view. The kyphoplasty balloon is simple to place through the standard portals and the advantage is that it allows easy manipulation of the arthroscopic instruments from the same portal.

  5. Sonographically guided posteromedial approach for intra-articular knee injections: a safe, accurate, and efficient method.

    Science.gov (United States)

    Tresley, Jonathan; Jose, Jean

    2015-04-01

    Osteoarthritis of the knee can be a debilitating and extremely painful condition. In patients who desire to postpone knee arthroplasty or in those who are not surgical candidates, percutaneous knee injection therapies have the potential to reduce pain and swelling, maintain joint mobility, and minimize disability. Published studies cite poor accuracy of intra-articular knee joint injections without imaging guidance. We present a sonographically guided posteromedial approach to intra-articular knee joint injections with 100% accuracy and no complications in a consecutive series of 67 patients undergoing subsequent computed tomographic or magnetic resonance arthrography. Although many other standard approaches are available, a posteromedial intra-articular technique is particularly useful in patients with a large body habitus and theoretically allows for simultaneous aspiration of Baker cysts with a single sterile preparation and without changing the patient's position. The posteromedial technique described in this paper is not compared or deemed superior to other standard approaches but, rather, is presented as a potentially safe and efficient alternative. © 2015 by the American Institute of Ultrasound in Medicine.

  6. Nitrous Oxide sedation for intra-articular injection in juvenile idiopathic arthritis

    Directory of Open Access Journals (Sweden)

    Harel Liora

    2008-01-01

    Full Text Available Abstract Background Intra-articular corticosteroid injection in juvenile idiopathic arthritis (JIA is often associated with anxiety and pain. Recent reports advocate the use of nitrous oxide (NO, a volatile gas with analgesic, anxiolytic and sedative properties. Objective To prospectively evaluate the effectiveness and safety of NO analgesia for intra-articular corticosteroid injection in JIA, and to assess patients and staff satisfaction with the treatment. Methods NO was administered to JIA patients scheduled for joint injection. The patient, parent, physician and nurse completed visual-analog scores (VAS (0–10 for pain, and a 5-point satisfaction scale. Change in heart rate (HR during the procedure was recorded in order to examine physiologic response to pain and stress. Patient's behavior and adverse reactions were recorded. Results 54 procedures (72 joints were performed, 41 females, 13 males; 39 Jewish, 13 Arab; mean age was 12.2 ± 4.7 year. The median VAS pain score for patients, parents, physicians and nurses was 3. The HR increased ≥ 15% in 10 patients. They had higher VAS scores as evaluated by the staff. The median satisfaction level of the parents and staff was 3.0 and 5.0 respectively. Adverse reactions were mild. Conclusion NO provides effective and safe sedation for JIA children undergoing intra-articular injections.

  7. Characterisation of intra-articular soft tissue tumours and tumour-like lesions

    Energy Technology Data Exchange (ETDEWEB)

    Adams, Matthew E. [The Royal National Orthopaedic Hospital NHS Trust, The Department of Radiology, Middlesex (United Kingdom); Saifuddin, Asif [The Royal National Orthopaedic Hospital NHS Trust, The Department of Radiology, Middlesex (United Kingdom); The London Bone and Soft Tissue Tumour Service, London (United Kingdom); University College London, The Institute of Orthopaedics and Musculoskeletal Sciences, London (United Kingdom)

    2007-04-15

    The aim of this study was to describe a new magnetic resonance imaging (MRI) classification system for intra-articular soft tissue tumours based on the morphology of the lesion, with the aim to aid the differential diagnosis. We performed a retrospective review of 52 consecutive patients presenting to a specialist musculoskeletal oncology unit with a suspected intra-articular tumour. Lesions were categorised into one of four groups according to a simple classification system based on their morphological features on MRI. Distinct groupings of pathologies emerged corresponding to each of the morphological categories. Particularly when combined with radiographic features of calcification and bone erosion, certain patterns were found to be characteristic of specific diagnoses. For example multifocal, calcified lesions were found exclusively in synovial osteochondromatosis and diffuse synovitis with hypointense T2-weighted signal intensity was typical of pigmented villonodular synovitis. Certain combinations of imaging features such as diffuse solid lesions and focal lesions with bone erosion were commonly associated with malignant lesions. We suggest that by classifying intra-articular masses according to their morphological features on MRI, particularly when combined with simple radiographic features, an additional parameter may be generated to aid the radiologist in making a diagnosis. In addition, particular combinations of features provide 'red flags' to increase the index of suspicion for malignancy. (orig.)

  8. Conservative treatment of intra-articular distal phalanx fractures in horses not used for racing.

    Science.gov (United States)

    Ohlsson, J; Jansson, N

    2005-04-01

    To determine the success rate and whether specific patient and treatment factors influenced the outcome after conservative treatment with a bar shoe with quarter clips of intra-articular fractures of the distal phalanx in horses not used for racing. Retrospective study. Thirty-two client-owned horses. Hospital records of horses that had been treated conservatively for intra-articular fractures of the distal phalanx at Skara Equine Hospital or Halland Animal Hospital in Sweden between 1995 and 2001 were reviewed. Racehorses in active training and horses affected with other musculoskeletal diseases were excluded from the study. Follow-up was performed by questionnaire and telephone inquires to the owners 1 to 7 years after injury. Twenty-two horses (69%) returned to their previous or expected level of use and did not wear their bar shoe when they were put back into training. There was no statistically significant correlation between outcome and patient or treatment variables, or bony union of the fracture. Conservative treatment of intra-articular fractures of the distal phalanx carries a fair prognosis for return to previous or expected level of use in horses not used for racing. Radiographic evidence of fracture healing and age of the patient do not seem to influence the prognosis. Horses not used for racing do not need to be shod with a bar shoe with quarter clips for the rest of their athletic career.

  9. Characterisation of intra-articular soft tissue tumours and tumour-like lesions

    International Nuclear Information System (INIS)

    Adams, Matthew E.; Saifuddin, Asif

    2007-01-01

    The aim of this study was to describe a new magnetic resonance imaging (MRI) classification system for intra-articular soft tissue tumours based on the morphology of the lesion, with the aim to aid the differential diagnosis. We performed a retrospective review of 52 consecutive patients presenting to a specialist musculoskeletal oncology unit with a suspected intra-articular tumour. Lesions were categorised into one of four groups according to a simple classification system based on their morphological features on MRI. Distinct groupings of pathologies emerged corresponding to each of the morphological categories. Particularly when combined with radiographic features of calcification and bone erosion, certain patterns were found to be characteristic of specific diagnoses. For example multifocal, calcified lesions were found exclusively in synovial osteochondromatosis and diffuse synovitis with hypointense T2-weighted signal intensity was typical of pigmented villonodular synovitis. Certain combinations of imaging features such as diffuse solid lesions and focal lesions with bone erosion were commonly associated with malignant lesions. We suggest that by classifying intra-articular masses according to their morphological features on MRI, particularly when combined with simple radiographic features, an additional parameter may be generated to aid the radiologist in making a diagnosis. In addition, particular combinations of features provide 'red flags' to increase the index of suspicion for malignancy. (orig.)

  10. Intra-articular pressures and joint mechanics: should we pay attention to effusion in knee osteoarthritis?

    Science.gov (United States)

    Rutherford, Derek James

    2014-09-01

    What factors play a role to ensure a knee joint does what it should given the demands of moving through the physical environment? This paper aims to probe the hypothesis that intra-articular joint pressures, once a topic of interest, have been left aside in contemporary frameworks in which we now view knee joint function. The focus on ligamentous deficiencies and the chondrocentric view of osteoarthritis, while important, have left little attention to the consideration of other factors that can impair joint function across the lifespan. Dynamic knee stability is required during every step we take. While there is much known about the role that passive structures and muscular activation play in maintaining a healthy knee joint, this framework does not account for the role that intra-articular joint pressures may have in providing joint stability during motion and how these factors interact. Joint injuries invariably result in some form of intra-articular fluid accumulation. Ultimately, it may be how the knee mechanically responds to this fluid, of which pressure plays a significant role that provides the mechanisms for continued function. Do joint pressures provide an important foundation for maintaining knee function? This hypothesis is unique and argues that we are missing an important piece of the puzzle when attempting to understand implications that joint injury and disease have for joint function. Copyright © 2014 Elsevier Ltd. All rights reserved.

  11. Amputação interescapulotorácica sob anestesia locorregional

    Directory of Open Access Journals (Sweden)

    José Alves de Moraes

    Full Text Available Forequarter amputations are an uncommon option for the treatment of upper limb and shoulder girdle tumors nowadays. This procedure can be done by different approaches and general anesthesia is commonly used. The authors report a case of forequarter amputation by the posterior approach performed for treatment of a soft-tissue sarcoma under a brachial plexus block associated with venous sedation and local anesthesia.

  12. Paresia transitória unilateral combinada do nervo hipoglosso e do nervo lingual após intubação para anestesia

    Directory of Open Access Journals (Sweden)

    Hulya Ulusoy

    2014-04-01

    Full Text Available Lesões de nervos podem ocorrer na região faringolaríngea durante a anestesia geral. Os nervos mais comumente lesionados são o hipoglosso, lingual e laríngeo recorrente. As lesões podem surgir em decorrência de vários fatores, como, por exemplo, durante a laringoscopia, intubação endotraqueal e inserção de tubo e por pressão do balão, ventilação com máscara, manobra aérea tripla, via aérea orofaríngea, modo de inserção do tubo, posição da cabeça e do pescoço e aspiração. As lesões nervosas nessa região podem acometer um único nervo isolado ou causar a paralisia de dois nervos em conjunto, como a do nervo laríngeo recorrente e hipoglosso (síndrome de Tapia. No entanto, a lesão combinada dos nervos lingual e hipoglosso após intubação para anestesia é uma condição muito mais rara. O risco dessa lesão pode ser reduzido por meio de medidas preventivas. Descrevemos um caso de paresia unilateral combinada dos nervos hipoglosso e lingual após intubação para anestesia.

  13. Risk of Infection After Intra-articular Steroid Injection at the Time of Ankle Arthroscopy in a Medicare Population.

    Science.gov (United States)

    Werner, Brian C; Cancienne, Jourdan M; Burrus, M Tyrrell; Park, Joseph S; Perumal, Venkat; Cooper, M Truitt

    2016-02-01

    To employ a national database to evaluate the association between intraoperative corticosteroid injection at the time of ankle arthroscopy and postoperative infection rates in Medicare patients. A national insurance database was queried for Medicare patients who underwent ankle arthroscopy, including arthroscopic removal of loose body, synovectomy, and limited or extensive debridement. Two groups were created: ankle arthroscopy with concomitant local steroid injection (n = 459) and a control group of patients who underwent ankle arthroscopy without intraoperative local steroid injection (n = 9,327). The demographics and Charlson Comorbidity Index of each group were compared. Infection rates within 6 months postoperatively were assessed using International Classification of Diseases, 9th revision, and Current Procedural Terminology codes and compared between groups using χ(2)-tests. A total of 9,786 unique patients who underwent ankle arthroscopy were included in the study. There were no statistically significant differences between the steroid injection study group and controls for the assessed infection-related variables, including gender, age group, obesity, smoking, and average Charlson Comorbidity Index. The infection rate for patients who had a local steroid injection at the time of surgery was 3.9% (18/459 patients), compared with 1.8% (168/9,327 patients) in the control group (odds ratio, 2.2; 95% confidence interval, 1.4 to 3.7; P = .002.) The majority of this difference was noted between the 65 and 79 years age groups. The use of intraoperative intraarticular corticosteroid injection at the time of ankle arthroscopy in Medicare patients is associated with significantly increased rates of postoperative infection compared with controls without intraoperative steroid injections. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  14. Influência da técnica de anestesia no tempo de ocupação de sala cirúrgica nas operações anorretais Influence of the anesthetic technique on the time spent in operating rooms in anorectal procedures

    Directory of Open Access Journals (Sweden)

    Paulo Gustavo Kotze

    2008-06-01

    Full Text Available INTRODUÇÃO: atualmente cerca de 90% das operações anorretais são realizadas em regime ambulatorial. A técnica anestésica é fator fundamental na busca de reduzido tempo de internação, agilidade no ambiente cirúrgico e redução de custos nestes procedimentos. Não há consenso na literatura sobre qual o melhor tipo de anestesia para essas operações. OBJETIVO: comparar o tempo de ocupação de sala cirúrgica em pacientes submetidos a operações anorretais através da técnica de raquianestesia com bupivacaína 0,5% isobárica comparada com a técnica de anestesia venosa com propofol associada ao bloqueio perianal local com lidocaína a 2% e bupivacaína 0,5%. MÉTODOS: Foram incluídos 99 pacientes divididos em 2 grupos: grupo I (raquianestesia, composto por 50 pacientes e grupo II (anestesia combinada, composto por 49 pacientes. Foram estudados os procedimentos cirúrgicos e o tempo de procedimento anestésico-cirúrgico, e medida indireta da ocupação da sala cirúrgica. RESULTADOS: Não houve diferença estatística significativa entre os grupos estudados em relação ao tipo de procedimento cirúrgico, sexo e idade. O tempo médio do procedimento anestésico-cirúrgico, no grupo I foi de 53,1 min e de 44,08 min no grupo II (p=0,034. CONCLUSÕES: As duas técnicas estudadas foram eficazes. Houve menor tempo de procedimento anestésico-cirúrgico nos pacientes operados com anestesia combinada, com significância estatística.INTRODUCTION: around ninety percent of anorectal surgical procedures are performed as day cases. The choice of a proper anesthetic technique is important to achieve reduced time in the operating rooms, hospital stay and low costs. There is no evidence in the literature that a superior type of anesthesia for these procedures exists. OBJECTIVE: to compare the time spent on operating rooms in patients submitted to anorectal surgical procedures through spinal anesthesia (0,5% bupivacaine with combined anesthesia

  15. Intra-articular temperatures of the knee in sports – An in-vivo study of jogging and alpine skiing

    Directory of Open Access Journals (Sweden)

    Cerulli Guiliano

    2008-04-01

    Full Text Available Abstract Background Up to date, no information exists about the intra-articular temperature changes of the knee related to activity and ambient temperature. Methods In 6 healthy males, a probe for intra-articular measurement was inserted into the notch of the right knee. Each subject was jogging on a treadmill in a closed room at 19°C room temperature and skiing in a ski resort at -3°C outside temperature for 60 minutes. In both conditions, temperatures were measured every fifteen minutes intra-articulary and at the skin surface of the knee. A possible influence on joint function and laxity was evaluated before and after activity. Statistical analysis of intra-articular and skin temperatures was done using nonparametric Wilcoxon's sign rank sum test and Mann-Whitney's-U-Test. Results Median intra-articular temperatures increased from 31.4°C before activity by 2.1°C, 4°C, 5.8°C and 6.1°C after 15, 30, 45 and 60 min of jogging (all p ≤ 0.05. Median intra-articular temperatures dropped from 32.2°C before activity by 0.5°C, 1.9°C, 3.6°C and 1.1°C after 15, 30, 45 and 60 min of skiing (all n.s.. After 60 minutes of skiing (jogging, the median intra-articular temperature was 19.6% (8.7% higher than the skin surface temperature at the knee. Joint function and laxity appeared not to be different before and after activity within both groups. Conclusion This study demonstrates different changes of intra-articular and skin temperatures during sports in jogging and alpine skiing and suggests that changes are related to activity and ambient temperature.

  16. Hipotensión arterial y variabilidad de la frecuencia cardiaca en pacientes embarazadas llevadas a cesarea bajo anestesia raquídea

    OpenAIRE

    Amaya Rios, Juan Carlos; Garcia Montaño, Nestor Ivan

    2015-01-01

    INTRODUCCION La hipotensión arterial por anestesia raquídea en embarazadas llevadas a cesárea es frecuente y deletérea para la madre y el feto, sin que a la fecha exista una herramienta clínicamente útil para predecirla. La variabilidad de la frecuencia cardiaca es una medida que estima la actividad del sistema nervioso autónomo y algunos estudio iniciales indican una posible utilidad como herramienta predictiva de hipotensión arterial en esta población. METODOLOGIA Se realizó un es...

  17. MRI features of three paediatric intra-articular synovial lesions: a comparative study

    Energy Technology Data Exchange (ETDEWEB)

    Kan, J.H. [Monroe Carell Jr. Children' s Hospital at Vanderbilt, Nashville, TN (United States)], E-mail: herman.kan@vanderbilt.edu; Hernanz-Schulman, M. [Monroe Carell Jr. Children' s Hospital at Vanderbilt, Nashville, TN (United States); Damon, B.M.; Yu, Chang [Vanderbilt University, Nashville, TN (United States); Connolly, S.A. [Boston Children' s Hospital, Boston, IL (United States)

    2008-07-15

    Aim: To determine reliable magnetic resonance imaging (MRI) features differentiating three paediatric intra-articular congenital or neoplastic synovial lesions that contain blood products, from post-traumatic or haemorrhagic inflammatory processes. Materials and methods: This was a retrospective review of MRI findings of 22 paediatric intra-articular congenital or neoplastic synovial lesions, including venous malformation (VM) (n = 12), pigmented villonodular synovitis (PVNS; n = 8), and synovial sarcoma (SS; n = 2). These MRI features were compared with 22 paediatric post-traumatic or inflammatory intra-articular processes containing blood products and producing mass effect. The following imaging features were assessed: presence of a discrete mass, extension, extra-articular oedema, susceptibility, joint effusion, and size. Fisher's exact test was used and results were considered statistically significant when p < 0.05. Results: The three intra-articular synovial lesions, compared with controls, were more likely to directly invade osseous structures when a discrete mass was present (13/16, 81.3% versus 1/9, 11.1%; p < 0.002) and extend into extra-articular soft tissues (13/21, 61.9% versus 2/17, 11.8%; p < 0.003), but were less likely to show extra-articular oedema (3/22, 13.6% versus 13/22, 59.1%; p < 0.004), a joint effusion (10/22,45.5% versus 19/22, 86.4%, p < 0.01), susceptibility within a joint effusion (0/22, 0% versus 11/22, 40.9%; p = 0.00), osseous oedema (3/16, 18.8% versus 7/9, 77.8%; p < 0.009), and synovial enhancement (8/21, 38.1% versus 14/16, 87.5%; p < 0.003). VMs had characteristic tubular vessels with internal fluid-fluid levels (11/12) that extended into bone (10/12) and extracapsular soft tissues (11/12). Conclusion: Our study indicates that, despite the overlapping presence of haemorrhagic products, intra-articular VM, PVNS, and SS show MRI features that permit distinction from acquired post-traumatic and haemorrhagic inflammatory

  18. Aplicação do monitor Narcotrend® para avaliar a profundidade da anestesia em crianças submetidas à cirurgia cardíaca: estudo prospectivo e controlado

    Directory of Open Access Journals (Sweden)

    Yiyan Jiang

    2013-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Investigar a eficácia clínica, segurança e viabilidade do monitor Narcotrend® para avaliar a profundidade da anestesia em crianças com doença cardíaca congênita (DCC submetidas à cirurgia cardíaca. MÉTODOS: Foram randomicamente selecionadas 80 crianças submetidas à anestesia geral em cirurgia seletiva. As crianças foram divididas em dois grupos de forma aleatória (n = 40 por grupo. No grupo Narcotrend, a profundidade da anestesia foi monitorada com o Narcotrend. No grupo padrão, a profundidade da anestesia foi controlada de acordo com a experiência clínica. A pressão arterial média (PAM e a frequência cardíaca (FC foram determinadas e a dose de fentanil e relaxante muscular e os tempos de recuperação e de extubação foram registrados. RESULTADOS: Em ambos os grupos, os sinais vitais apresentaram-se estáveis durante a cirurgia. No grupo Narcotrend, a PAM e a FC foram mais estáveis, a dose total de fentanil e relaxante muscular significativamente menor e os tempos de recuperação e extubação acentuadamente mais reduzidos em comparação com o grupo padrão. CONCLUSÃO: A aplicação do monitor Narcotrend para medir a profundidade da anestesia foi útil para controlar a profundidade da anestesia em crianças com DCC que receberam anestesia intravenosa total, na qual uma pequena quantidade de narcóticos pode obter a anestesia ideal. Além disso, os tempos de recuperação e extubação foram menores e os efeitos secundários, como sensibilização intraoperatória, puderam ser evitados.

  19. ANESTESIA BALANCEADA EM LAGARTO-TEIÚ (Tupinambis merianae: RELATO DE CASO

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    Erica Cristina Bueno do Prado Guirro

    2010-06-01

    Full Text Available A tegu lizard tupinambis merianae submitted to osteosynthesison umero received midazolam (0.073mg/kg, i.m. andmorphine (0.224mg/kg, i.m. in pre-medication. The animal wasinduced by ketamine (30mg/kg, i.m. and anesthesia was maintainedwith isofluorane diluted in O2 (1L/Kg/min and supplied byfacial mask, besides local anesthesia with lidocaine 2% withoutadrenaline (5mg/kg. This anesthesia protocol was efficient andsafe to patient.

  20. The Unexplored Role of Intra-articular Adipose Tissue in the Homeostasis and Pathology of Articular Joints

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    Luminita Labusca

    2018-03-01

    Full Text Available Intra-articular adipose tissue deposits known as articular fat pads (AFPs are described to exist within synovial joints. Their assumed role in normal joint biomechanics is increasingly objectivized by means of advanced methods of functional imaging. AFPs possess structural similarity with body subcutaneous white adipose tissue (WAT, however, seems to be regulated by independent metabolic loops. AFP dimension are conserved during extreme WAT states: obesity, metabolic syndrome, lipodystrophy, and cachexia. Hoffa fat pad (HFP in the knee is increasingly recognized as a major player in pathological joint states such as anterior knee pain and osteoarthritis. HFP contains numerous population of mesenchymal and endothelial progenitors; however, the possible role of mature adipocytes in the maintenance of stem cell niche is unknown. We propose that AFP is an active component of the joint organ with multifunctional roles in the maintenance of joint homeostasis. Endowed with a rich network of sensitive nervous fibbers, AFPs may act as a proprioceptive organ. Adipokines and growth factors released by AFP-resident mature adipocytes could participate in the maintenance of progenitor stem cell niche as well as in local immune regulation. AFP metabolism may be locally controlled, correlated with but independent of WAT homeostasis. The identification of AFP role in normal joint turnover and its possible implication in pathological states could deliver diagnostic and therapeutic targets. Drug and/or cell therapies that restore AFP structure and function could become the next step in the design of disease modifying therapies for disabling joint conditions such as osteoarthritis and inflammatory arthritis.

  1. O primeiro a utilizar anestesia em cirurgia não foi um dentista. Foi o m édico Crawford Williamson Long El primero en utilizar la anestesia en cirugía no fue un dentista, fue el médico Crawford Williamson Long The first to use surgical anesthesia was not a dentist, but the physician Crawford Williamson Long

    Directory of Open Access Journals (Sweden)

    Almiro dos Reis Júnior

    2006-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A história da descoberta da anestesia continua incompletamente esclarecida em vários de seus aspectos. Mas é fácil definir que Crawford Williamson Long foi o primeiro a utilizar o éter sulfúrico para operar vários pacientes, sem dor, e realizar analgesias obstétricas. A história é uma ponte que liga o passado ao presente e deve ser estudada e entendida desde os seus primeiros pilares. Assim, justifica-se lembrar ou dar a conhecer quem foi Long, um nome certamente pouco conhecido entre nós, e qual a participação dele na descoberta da anestesia. CONTEÚDO: São discorridos porque e como Crawford Williamson Long foi levado a se tornar o primeiro médico a operar sem dor, quatro anos e meio antes de Morton, e o papel que desempenhou numa das maiores descobertas da Medicina. A biografia de Long é narrada, ressaltando-se o seu caráter, a competência, a dedicação, a modéstia, o desprendimento e um certo desapego com relação à conquista da glória. Descrevem-se as circunstâncias que o levaram a não divulgar de imediato sua descoberta. É analisado o envolvimento de Long na discussão pela primazia da descoberta da anestesia e relatado o seu falecimento. As numerosas homenagens recebidas por Long nos EUA e em outros países são citadas. CONCLUSÕES: W. T. G. Morton costuma ser considerado como o autor da descoberta da anestesia geral, sobretudo por ter sido o primeiro a fazer demonstração pública bem-sucedida, em importante hospital de Boston (EUA. Contudo, provou-se que Long foi o primeiro a utilizar a anestesia cirúrgica e é reconhecido em várias regiões de seu país como o pai da anestesia cirúrgica e "o seu descobridor". É necessário, ainda, reverter o fato de ser Long pouco conhecido entre nós e inseri-lo no lugar a que tem direito na história da anestesia geral.JUSTIFICATIVA Y OBJETIVOS: La historia del descubrimiento de la anestesia continúa sin ser completamente aclarada en varios

  2. Insuficiência respiratória aguda durante anestesia pediátrica: atelectasia e pneumotórax hipertensivo: relato de caso

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    Joel Massari Rezende

    2012-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A tarefa primordial do anestesiologista é garantir a adequada oxigenação do paciente. O objetivo deste relato é des crever o diagnóstico e conduta em um caso de insuficiência respiratória aguda durante anestesia, com finalidade didática. RELATO DO CASO: Criança de três anos submetida à anestesia para cirurgia urológica apresentou insuficiência respiratória por obstruções de brônquios por secreção, evoluindo com atelectasia e pneumotórax hipertensivo. Apresentamos o desenrolar do caso, e os meios de tratamento aplicado, com destaque para a urgência e técnica da drenagem no pneumotórax hipertensivo. CONCLUSÕES: A atenção do anestesiologista para o diagnóstico precoce de complicações respiratórias e o conhecimento das medidas prioritárias em cada momento pode evitar efeitos adversos graves

  3. Outcome after open reduction and internal fixation of intraarticular fractures of the calcaneum without the use of bone grafts

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    Pendse Aniruddha

    2006-01-01

    Full Text Available Background: Intraarticular fractures of calcaneum are commenest type of calcaneal fractures. Lots of controversies exist about the ideal management for them. The focus is now shifting on operative management by open reduction and internal fixation for these fractures with or without the use of bone grafts. Method: Thirty intraarticular fractures classified by Essex Lopresti radiological classification, were treated by open reduction and fixation. The patients were followed over a mean period of 30 months (25-40 months. Results: All the fractures united at a mean duration of 14 weeks. 86% patients had excellent functional outcome with one patient having fair and one having poor functional outcome. Conclusion: Open reduction and internal fixation with plate is a good method for treatment of intraarticular fractures of calcaneum to achieve anatomical restoration of articular surface under vision, stable fixation, early mobilization and an option for primary subtalar arthrodesis if deemed necessary.

  4. Anestesia para paciente portador da equência de moebius: relato de caso Anestesia para Paciente Portador de la Secuencia de Moebius: relato de Caso Anesthesia in a patient with moebius sequence: case report

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    Adriano Bechara de Souza Hobaika

    2009-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A sequência de Moebius (SM é uma rara paralisia do VI e VII nervos cranianos. Alterações craniofaciais estão presentes em aproximadamente 90% destes pacientes, o que pode tornar a intubação traqueal muito difícil. RELATO DO CASO: Paciente do sexo masculino, 2 anos e 5 meses, portador de SM, submetido à broncoscopia flexível para avaliação de laringotraqueomalácia. Comorbidades: crises de broncoespasmo e comunicação interventricular. Realizou-se indução anestésica com sevoflurano em O2 a 100% e venóclise. Introduziu-se máscara laríngea AMBU® número 2,5 e o fibrobroncoscópio foi introduzido através da mesma. O procedimento foi realizado sem complicações e a broncoscopia revelou-se normal. O paciente recebeu alta para casa após duas horas. CONCLUSÕES: O controle das vias aéreas é o grande desafio nestes pacientes, havendo relato de falha ou dificuldade de intubação em 13 pacientes de uma série de 41 casos analisados. Micrognatia, retrognatia, hipoplasia mandibular e fenda palatina são algumas características destes pacientes. Em outra grande série com 106 anestesias em pacientes com SM há descrição do uso da máscara laríngea em um caso. Parece não haver contra-indicação a realizar o procedimento em regime ambulatorial. Há relato de aspiração pulmonar e obstrução respiratória na sala de recuperação devido à dificuldade em deglutir e eliminar as secreções da boca e recomenda-se administrar antisialogogos.JUSTIFICATIVA Y OBJETIVOS: La secuencia de Moebius (SM es una rara parálisis del VI y VII nervios cranianos. Las alteraciones craneofaciales están presentes en aproximadamente un 90% de esos pacientes, lo que puede hacer con que la intubación traqueal sea muy difícil. RELATO DEL CASO: Paciente del sexo masculino, 2 años y 5 meses, portador de SM, sometido a la broncoscopia flexible para la evaluación de laringotraqueomalacia. Comorbidades: crisis de broncoespasmo

  5. Anestesia no cardiovascular en el paciente con cardiopatía congénita y flujo pulmonar aumentado

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    Lincoln de la Parte Pérez

    2003-12-01

    Full Text Available Los lactantes y dentro de éstos los de menor edad y peso corporal, que padecen de cardiopatías congénitas con flujo pulmonar aumentado y son sometidos a anestesia para procedimientos quirúrgicos no cardiovasculares, tienen un gran riesgo anestésico, por lo que es necesario enfatizar que estos pacientes presentan habitualmente múltiples alteraciones anatómicas y de la fisiología cardiovascular con repercusión en diferentes órganos y sistemas, diversas enfermedades asociadas que empeoran el pronóstico y necesitan frecuentemente tratamiento médico con digitálicos, diuréticos y fármacos vasoactivos desde muy temprano, de modo que la evaluación preoperatoria, incluidas las investigaciones no invasivas, deben ser realizadas por cardiólogos experimentados y cuando se programan para procedimientos quirúrgicos, deben ser remitidos para un centro con recursos y la experiencia necesaria en el manejo de los pacientes con cardiopatías congénitas. Se presenta una revisión bibliográfica actualizada sobre el manejo anestésico de estos pacientes.Infants and among them the youngest and with the least body weight suffering from congenital heart diseases with increased pulmonary flow and who receive anesthesia to undergo noncardiovascular surgical procedures, are at a great anesthetic risk . That's why, it is necessary to make emphasis on the fact that these patients usually present multiple anatomical alterations and cardiovascular physiology disorders with repercussion on different organs and systems, diverse associated diseases that worsen the prognosis, and that they frequently need medical treatment with digitalis, diuretics and vasoactive drugs very early. Taking this into account, the preoperative evaluation, including non-invasive research should be carried out by experienced cardiologists and when they are scheduled for surgical procedures, they should be referred to a center with resources and the necessary experience in the

  6. Tumores Productores de Aminas Simpáticas en el Niño y Anestesia

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    Joaquín L de la Lastra Rodríguez

    1999-09-01

    possible appareance of cardiac arrhytmias. The experience obtained in the management of a 7-year-old boy that had a tumor localized in a suprarenal gland with diagnosis of pheocromocytoma is presented in this paper.

  7. Fluoroscopy-Guided Sacroiliac Intraarticular Injection via the Middle Portion of the Joint.

    Science.gov (United States)

    Kurosawa, Daisuke; Murakami, Eiichi; Aizawa, Toshimi

    2017-09-01

    Sacroiliac intraarticular injection is necessary to confirm sacroiliac joint (SIJ) pain and is usually performed via the caudal one-third portion of the joint. However, this is occasionally impossible for anatomical reasons, and the success rate is low in clinical settings. We describe a technique via the middle portion of the joint. Observational study. Enrolled were 69 consecutive patients (27 men and 42 women, with an average age of 53 years) in whom the middle portion of 100 joints was targeted. With the patient lying prone-oblique with the painful side down, a spinal needle was inserted into the middle portion of the joint. Subsequently, the fluoroscopy tube was angled at a caudal tilt of 25-30° to clearly detect the recess between the ilium and sacrum and the needle depth and direction. When the needle reached the posterior joint line, 2% lidocaine was injected after the contrast medium outlined the joint. The success rate of the injection method was 80% (80/100). Among 80 successful cases, four were previously unsuccessful when the conventional method was used. Intraarticular injection using the new technique was unsuccessful in 20 joints; in three of these cases, the conventional method proved successful, and no techniques were successful in the other 17 cases. The injection technique via the middle portion of the joint can overcome some of the difficulties of the conventional injection method and can improve the chances of successful intraarticular injection. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  8. Intra-articular Physeal Fractures of the Distal Femur: A Frequently Missed Diagnosis in Adolescent Athletes.

    Science.gov (United States)

    Pennock, Andrew T; Ellis, Henry B; Willimon, Samuel C; Wyatt, Charles; Broida, Samuel E; Dennis, M Morgan; Bastrom, Tracey

    2017-10-01

    Intra-articular physeal fractures of the distal femur are an uncommon injury pattern, with only a few small case series reported in the literature. To pool patients from 3 high-volume pediatric centers to better understand this injury pattern, to determine outcomes of surgical treatment, and to assess risk factors for complications. Case series; Level of evidence, 4. A multicenter retrospective review of all patients presenting with an intra-articular physeal fracture between 2006 and 2016 was performed. Patient demographic and injury data, surgical data, and postoperative outcomes were documented. Radiographs were evaluated for fracture classification (Salter-Harris), location, and displacement. Differences between patients with and without complications were compared by use of analysis of variance or chi-square tests. A total of 49 patients, with a mean age of 13.5 years (range, 7-17 years), met the inclusion criteria. The majority of fractures were Salter-Harris type III fractures (84%) involving the medial femoral condyle (88%). Football was responsible for 50% of the injuries. The initial diagnosis was missed in 39% of cases, and advanced imaging showed greater mean displacement (6 mm) compared with radiographs (3 mm). All patients underwent surgery and returned to sport with "good to excellent" results after 2 years. Complications were more common in patients with wide-open growth plates, patients with fractures involving the lateral femoral condyle, and patients who were casted ( P < .05). Clinicians evaluating skeletally immature athletes (particularly football players) with acute knee injuries should maintain a high index of suspicion for an intra-articular physeal fracture. These fractures are frequently missed, and advanced imaging may be required to establish the diagnosis. Leg-length discrepancies and angular deformities are not uncommon, and patients should be monitored closely. Surgical outcomes are good when fractures are identified, with high rates

  9. Intra-articular pathology associated with isolated posterior cruciate ligament injury on MRI

    Energy Technology Data Exchange (ETDEWEB)

    Ringler, Michael D.; Collins, Mark S.; Howe, B.M. [Mayo Clinic, Department of Radiology, Rochester, MN (United States); Shotts, Ezekiel E. [NEA Baptist Clinic, Jonesboro, AR (United States)

    2016-12-15

    Unlike with anterior cruciate ligament injury, little is known about the prevalence of intra-articular pathology associated with isolated posterior cruciate ligament (PCL) injury in the knee. The objectives of this study were to characterize and identify the frequency of meniscal tears and osteochondral injuries in these patients, and to see if management might be affected. Altogether, 48 knee MRI exams with isolated PCL tears were evaluated for the presence of: grade and location of PCL tear, meniscal tear, articular chondral lesion, bone bruise, and fracture. Comparisons between PCL tear grade and location, as well as mechanism of injury when known, with the presence of various intra-articular pathologies, were made using the chi-square or Fisher's exact test as appropriate. In all, 69 % of isolated PCL tears occur in the midsubstance, 27 % proximally. Meniscal tears were seen in 25 % of knees, involving all segments of both menisci, except for the anterior horn medial meniscus. Altogether, 23 % had focal cartilage lesions, usually affecting the central third medial femoral condyle and medial trochlea, while 12.5 % of knees had fractures, and 48 % demonstrated bone bruises, usually involving the central to anterior tibiofemoral joint. The presence of a fracture (p = 0.0123) and proximal location of PCL tear (p = 0.0016) were both associated with the hyperextension mechanism of injury. There were no statistically significant associations between PCL tear grade and presence of intra-articular abnormality. Potentially treatable meniscal tears and osteochondral injuries are relatively prevalent, and demonstrable on MRI in patients with isolated acute PCL injury of the knee. (orig.)

  10. Outcomes of the distal intraarticular humeral fractures treated by olecranon osteotomy

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    Erhan Yılmaz

    2009-01-01

    Full Text Available Objectives: To evaluate the management and outcome of intraarticular fractures of the distal humerus treated by open reduction and internal fixation using the olecranon osteotomy technique. Materials and methods: Twenty-one patients with in-traarticular fractures of the distal humerus were treated by open reduction and internal fixation. The mean age of the patients was 41.6 years and the mean follow-up pe-riod was 25.3 months. All fractures were type C accord-ing to the AO/ASIF fracture classification system. Chev-ron type olecranon osteotomy was performed within 12-24 h after the injury in all cases but 4 of them. Physical and radiological examination of patients with the appro-priate range checks were made.Results: All fractures united within average duration of 3.2 months. Excellent or good results were found in pa-tients less than 50 years-old, in women, when passing time from injury to surgery was within 12 hours and when early mobilization was achieved. The complica-tions were seen as 2 (9.6% transient neuropraxia of the ulnar nerve, 2 (9.6% failure of fixation, 1 (4.8% het-erotopic ossification and 1 (4.8% olecranon non-union. Fracture type (C1 and time from occurrence of injury to surgery (<12 hours are the main prognostic factors for achieving the excellent/ good functional results.Conclusions: The critical factors for a successful out-come of intraarticular fractures of the distal humerus in-cluded meticulous surgical technique, stable internal fix-ation, surgical experimentation and early controlled postoperative mobilization.

  11. The Timing of Hip Arthroscopy After Intra-articular Hip Injection Affects Postoperative Infection Risk.

    Science.gov (United States)

    Wang, Dean; Camp, Christopher L; Ranawat, Anil S; Coleman, Struan H; Kelly, Bryan T; Werner, Brian C

    2017-11-01

    To evaluate the association of preoperative intra-articular hip injection with surgical site infection after hip arthroscopy. A large administrative database was used to identify all patients undergoing hip arthroscopy from 2007 to 2015 within a single private insurer and from 2005 to 2012 within Medicare in the United States. Those that received an ipsilateral preoperative intra-articular hip injection were identified. The patients were then divided into the following groups based on the interval between preoperative injection and ipsilateral hip arthroscopy: (1) 12 months) of preoperative hip injection. Patients developing a surgical site infection within 6 months following hip arthroscopy were identified using International Classification of Diseases, Ninth Revision, and Current Procedural Terminology codes associated with infection. Groups were compared using a multivariate logistic regression analysis to control for age, gender, body mass index, smoking status, alcohol usage, and multiple medical comorbidities including diabetes mellitus, hemodialysis use, inflammatory arthritis, and peripheral vascular disease. In total, 19% of privately insured and 6% of Medicare patients received a hip injection within 12 months of hip arthroscopy. The overall infection rate in privately insured and Medicare patients was 1.19% and 1.10%, respectively. Preoperative hip injection within 3 months of surgery was associated with a significantly higher risk of postoperative infection versus controls (2.16%, odds ratio [OR] 6.1, P arthroscopy increased when preoperative intra-articular hip injections were given within 3 months of surgery. Level III, retrospective comparative study. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  12. Effectiveness of intra-articular lidocaine injection for reduction of anterior shoulder dislocation: randomized clinical trial

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    Marcel Jun Sugawara Tamaoki

    Full Text Available CONTEXT AND OBJECTIVE: Shoulder dislocation is the most common dislocation among the large joints. The aim here was to compare the effectiveness of reduction of acute anterior shoulder dislocation with or without articular anesthesia. DESIGN AND SETTING: Prospective randomized trial conducted in Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp. METHODS: From March 2008 to December 2009, 42 patients with shoulder dislocation were recruited. Reductions using traction-countertraction for acute anterior shoulder dislocation with and without lidocaine articular anesthesia were compared. As the primary outcome, pain was assessed through application of a visual analogue scale before reduction, and one and five minutes after the reduction maneuver was performed. Complications were also assessed. RESULTS: Forty-two patients were included: 20 in the group without analgesia (control group and 22 in the group that received intra-articular lidocaine injection. The group that received intra-articular lidocaine had a statistically greater decrease in pain over time than shown by the control group, both in the first minute (respectively: mean 2.1 (0 to 5.0, standard deviation, SD 1.3, versus mean 4.9 (2.0 to 7.0, SD 1.5; P < 0.001 and the fifth minute (respectively: mean 1.0; 0 to 3.0; SD = 1.0 versus mean 4.0; 1.0 to 6.0; SD = 1.4; P < 0.001. There was one failure in the control group. There were no other complications in either group. CONCLUSION: Reduction of anterior shoulder dislocation using intra-articular lidocaine injection is effective, since it is safe and diminishes the pain. CLINICAL TRIAL REGISTRATION: ISRCTN27127703.

  13. Effectiveness of intra-articular lidocaine injection for reduction of anterior shoulder dislocation: randomized clinical trial.

    Science.gov (United States)

    Tamaoki, Marcel Jun Sugawara; Faloppa, Flavio; Wajnsztejn, André; Archetti Netto, Nicola; Matsumoto, Marcelo Hide; Belloti, João Carlos

    2012-01-01

    Shoulder dislocation is the most common dislocation among the large joints. The aim here was to compare the effectiveness of reduction of acute anterior shoulder dislocation with or without articular anesthesia. Prospective randomized trial conducted in Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp). From March 2008 to December 2009, 42 patients with shoulder dislocation were recruited. Reductions using traction-countertraction for acute anterior shoulder dislocation with and without lidocaine articular anesthesia were compared. As the primary outcome, pain was assessed through application of a visual analogue scale before reduction, and one and five minutes after the reduction maneuver was performed. Complications were also assessed. Forty-two patients were included: 20 in the group without analgesia (control group) and 22 in the group that received intra-articular lidocaine injection. The group that received intra-articular lidocaine had a statistically greater decrease in pain over time than shown by the control group, both in the first minute (respectively: mean 2.1 (0 to 5.0), standard deviation, SD 1.3, versus mean 4.9 (2.0 to 7.0, SD 1.5; P < 0.001) and the fifth minute (respectively: mean 1.0; 0 to 3.0; SD = 1.0 versus mean 4.0; 1.0 to 6.0; SD = 1.4; P < 0.001). There was one failure in the control group. There were no other complications in either group. Reduction of anterior shoulder dislocation using intra-articular lidocaine injection is effective, since it is safe and diminishes the pain. ISRCTN27127703.

  14. Assessment of clinical practice guideline methodology for the treatment of knee osteoarthritis with intra-articular hyaluronic acid.

    Science.gov (United States)

    Altman, Roy D; Schemitsch, Emil; Bedi, Asheesh

    2015-10-01

    Clinical practice guidelines are of increasing importance in the decision making for the treatment of knee osteoarthritis. Inconsistent recommendations regarding the use of intra-articular hyaluronic acid for the treatment of knee osteoarthritis have led to confusion among treating physicians. Literature search to identify clinical practice guidelines that provide recommendations regarding the use of intra-articular hyaluronic acid treatment for knee osteoarthritis was conducted. Included guidelines were appraised using the AGREE II instrument. Guideline development methodologies, how the results were assessed, the recommendation formation, and work group composition were summarized. Overall, 10 clinical practice guidelines were identified that met our inclusion criteria. AGREE II domain scores were variable across the included guidelines. The methodology utilized across the guidelines was heterogeneous regarding the evidence inclusion criteria, analysis of evidence results, formulation of clinical practice recommendations, and work group composition. The recommendations provided by the guidelines for intra-articular hyaluronic acid treatment for knee osteoarthritis are highly inconsistent as a result of the variability in guideline methodology. Overall, 30% of the included guidelines recommended against the use of intra-articular hyaluronic acid in the treatment of knee osteoarthritis, while 30% deemed the treatment an appropriate intervention under certain scenarios. The remaining 40% of the guidelines provided either an uncertain recommendation or no recommendation at all, based on the high variability in reviewed evidence regarding efficacy and trial quality. There is a need for a standard "appropriate methodology" that is agreed upon for osteoarthritis clinical practice guidelines in order to prevent the development of conflicting recommendations for intra-articular hyaluronic acid treatment for knee osteoarthritis, and to assure that treating physicians who

  15. Alterações transitórias do exame neurológico durante o despertar da anestesia com enflurano, isoflurano ou sevoflurano Alteraciones transitorias del examen neurológico durante el despertar de la anestesia con enflurano, isoflurano o sevoflurano Transient neurological changes during emergence from enflurane, isoflurane or sevoflurane anesthesia

    Directory of Open Access Journals (Sweden)

    Luiz Fernando Soares

    2001-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Anormalidades transitórias do exame neurológico ocorrem durante o despertar da anestesia com halotano, enflurano e isoflurano. Pouco se conhece sobre a ocorrência de anormalidades do exame neurológico durante a recuperação da anestesia com sevoflurano. Este estudo teve como objetivo comparar a prevalência de tais achados durante a recuperação da anestesia com enflurano (Grupo E, isoflurano (Grupo I e sevoflurano (Grupo S. MÉTODO: Foram estudados 44 pacientes que receberam anestesia com enflurano, isoflurano ou sevoflurano em N2O a 50%. Foram anotados antes da indução, imediatamente após a cessação da administração do anestésico e 5, 10, 15, 20, 30 e 40 minutos após: temperatura timpânica, nível de consciência, tônus muscular, reflexos pupilar, ciliar, bicipital, patelar e cutâneo-plantar, bem como a ocorrência de calafrios. RESULTADOS: As respostas dos reflexos pupilar, ciliar, patelar e cutâneo-plantar correlacionaram-se com o nível de consciência. Os grupos não diferiram quanto à prevalência de hipertonia muscular, hiperreflexia bicipital, clônus plantar e resposta extensora cutâneo-plantar. Hiperreflexia patelar foi mais freqüente no grupo do enflurano do que no grupo do isoflurano. Calafrios foram mais freqüentes nos grupos E e I do que no grupo do sevoflurano. A temperatura timpânica não diferiu entre os pacientes que apresentaram ou não calafrios. CONCLUSÕES: Alterações reversíveis do exame neurológico podem estar presentes por até 40 minutos durante a recuperação da anestesia com enflurano, isoflurano ou sevoflurano.JUSTIFICATIVA Y OBJETIVOS: Anormalidades transitorias del examen neurológico ocurren durante el despertar de la anestesia con halotano, enflurano e isoflurano. Poco se conoce sobre la ocurrencia de anormalidades del examen neurológico durante la recuperación de la anestesia con sevoflurano. Este estudio tuvo como objetivo comparar la prevalencia de tal

  16. Pharmacokinetics of 400 mg ropivacaine after periarticular local infiltration analgesia for total knee arthroplasty

    NARCIS (Netherlands)

    Fenten, M.G.E.; Bakker, S.M.; Touw, D.J.; Bemt, B.J.F van den; Scheffer, G.J.; Heesterbeek, P.J.C.; Stienstra, R.

    2017-01-01

    BACKGROUND: Although considered safe, no pharmacokinetic data of high dose, high volume local infiltration analgesia (LIA) with ropivacaine without the use of a surgical drain or intra-articular catheter have been described. The purpose of this study is to describe the maximum total and unbound

  17. Pharmacokinetics of 400 mg ropivacaine after periarticular local infiltration analgesia for total knee arthroplasty

    NARCIS (Netherlands)

    Fenten, M.; Bakker, S.; Heesterbeek, P.; Van Den Bemt, B.; Scheffer, G.J.; Touw, D.; Stienstra, R.

    2016-01-01

    Background and Aims: Although considered safe, no pharmacokinetic data of high dose, high volume local infiltration analgesia (LIA) with ropivacaine without the use of a surgical drain or intra-articular catheter have been described. The purpose of this study is to describe the maximum total and

  18. Pharmacokinetics of 400 mg ropivacaine after periarticular local infiltration analgesia for total knee arthroplasty

    NARCIS (Netherlands)

    Fenten, M. G. E.; Bakker, S. M. K.; Touw, D. J.; van den Bemt, B. J. F.; Scheffer, G. J.; Heesterbeek, P. J. C.; Stienstra, R.

    Background: Although considered safe, no pharmacokinetic data of high dose, high volume local infiltration analgesia (LIA) with ropivacaine without the use of a surgical drain or intra-articular catheter have been described. The purpose of this study is to describe the maximum total and unbound

  19. Synergistic effects of intravenous and intra-articular tranexamic acid on reducing hemoglobin loss in revision total knee arthroplasty: a prospective, randomized, controlled study.

    Science.gov (United States)

    Yuan, Xiangwei; Wang, Jiaxing; Wang, Qiaojie; Zhang, Xianlong

    2018-04-01

    Tranexamic acid decreases blood loss in primary total knee arthroplasty, and no related prospective randomized clinical trials have been conducted to evaluate the effectiveness and safety of tranexamic acid in revision total knee arthroplasty. Thus, we conducted this work to evaluate the synergistic effects of intravenous plus intra-articular tranexamic acid on reducing hemoglobin loss compared with intra-articular tranexamic acid alone in revision total knee arthroplasty. This prospective, controlled study randomized 96 patients undergoing revision total knee arthroplasty into two groups: an intravenous plus intra-articular tranexamic acid group (48 patients who received 20 mg/kg intravenous tranexamic acid and 3.0 g intra-articular tranexamic acid); and an intra-articular tranexamic acid alone group (48 patients who received the same intravenous volume of normal saline and 3.0 g intra-articular tranexamic acid). The primary outcome was hemoglobin loss. Secondary outcomes included the volume of drain output, the percentage of patients who received transfusions, the number of units transfused, and thromboembolic events. The baseline data, preoperative hemoglobin, and tourniquet time were similar in both groups. There was significantly less hemoglobin loss in the intravenous plus intra-articular tranexamic acid group compared with the intra-articular tranexamic acid alone group (2.7 ± 0.6 g/dL and 3.7 ± 0.7 g/dL; p tranexamic acid alone group, the intravenous plus intra-articular tranexamic acid group also had significantly less drain output, fewer patients who received transfusions, and fewer units transfused (all p tranexamic acid alone, combined intravenous plus intra-articular tranexamic acid significantly reduced hemoglobin loss and the need for transfusion without an apparent increase in thromboembolic events in patients who underwent revision total knee arthroplasty. © 2018 AABB.

  20. Chondrogenic Effect of Intra-articular Hypertonic-Dextrose (Prolotherapy) in Severe Knee Osteoarthritis.

    Science.gov (United States)

    Topol, Gastón Andrés; Podesta, Leandro Ariel; Reeves, Kenneth Dean; Giraldo, Marcia Mallma; Johnson, Lanny L; Grasso, Raul; Jamín, Alexis; Clark, Tom; Rabago, David

    2016-11-01

    Dextrose injection is reported to improve knee osteoarthritis (KOA)-related clinical outcomes, but its effect on articular cartilage is unknown. A chondrogenic effect of dextrose injection has been proposed. To assess biological and clinical effects of intra-articular hypertonic dextrose injections (prolotherapy) in painful KOA. Case series with blinded arthroscopic evaluation before and after treatment. Physical medicine and day surgery practice. Symptomatic KOA for at least 6 months, arthroscopy-confirmed medial compartment exposed subchondral bone, and temporary pain relief with intra-articular lidocaine injection. Four to 6 monthly 10-mL intra-articular injections with 12.5% dextrose. Visual cartilage growth assessment of 9 standardized medial condyle zones in each of 6 participants by 3 arthroscopy readers masked to pre-/postinjection status (total 54 zones evaluated per reader); biopsy of a cartilage growth area posttreatment, evaluated using hematoxylin and eosin and Safranin-O stains, quantitative polarized light microscopy, and immunohistologic cartilage typing; self-reported knee specific quality of life using the Western Ontario McMaster University Osteoarthritis Index (WOMAC, 0-100 points). Six participants (1 female and 5 male) with median age of 71 years, WOMAC composite score of 57.5 points, and a 9-year pain duration received a median of 6 dextrose injections and follow-up arthroscopy at 7.75 months (range 4.5-9.5 months). In 19 of 54 zone comparisons, all 3 readers agreed that the posttreatment zone showed cartilage growth compared with the pretreatment zone. Biopsy specimens showed metabolically active cartilage with variable cellular organization, fiber parallelism, and cartilage typing patterns consistent with fibro- and hyaline-like cartilage. Compared with baseline status, the median WOMAC score improved 13 points (P = .013). Self-limited soreness after methylene blue instillation was noted. Positive clinical and chondrogenic effects were seen

  1. Treatment of intraarticular displaced fractures of the calcaneus bone using nail blocked calcanail

    OpenAIRE

    Weiss, Marcin; Dolata, Tomasz; Weiss, Waldemar; Maksymiak, Martyna; Kałużny, Krystian; Kałużna, Anna; Zukow, Walery; Hagner‑Derengowska, Magdalena

    2018-01-01

    Weiss Marcin, Dolata Tomasz, Weiss Waldemar, Maksymiak Martyna, Kałużny Krystian, Kałużna Anna, Zukow Walery, Hagner‑Derengowska Magdalena. Treatment of intraarticular displaced fractures of the calcaneus bone using nail blocked calcanail. Journal of Education, Health and Sport. 2018;8(4):338-345. eISNN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.1226782 http://ojs.ukw.edu.pl/index.php/johs/article/view/5439 https://pbn.nauka.gov.pl/sedno-webapp/works/863609 ...

  2. Hip arthroscopy: prevalence of intra-articular pathologic findings after traumatic injury of the hip.

    Science.gov (United States)

    Khanna, Vickas; Harris, Adam; Farrokhyar, Forough; Choudur, Hema N; Wong, Ivan H

    2014-03-01

    The purpose of this study was to document and compare the incidence of intra-articular hip pathologic findings identified using arthroscopy versus conventional imaging in patients with acute trauma to the hip. This was a blinded prospective case series study designed to review the incidence of intra-articular pathologic disorders in patients with post-traumatic injury between the ages of 18 and 65 years who were referred to a single surgeon. Injuries included hip dislocation, proximal femur fracture, pelvic ring fracture, acetabular fracture, penetrating injury (gunshot wound), and soft tissue injury. Preoperative radiographs, computed tomographic (CT) scans, or magnetic resonance imaging/magnetic resonance angiography (MRI/MRA) scans (or a combination of these) were obtained. Findings were documented and compared with intraoperative findings. A total of 29 post-traumatic hips were enrolled in this study. Hip arthroscopy identified 17 of 29 hips (59%) as having loose bodies, 11 of 29 (38%) hips as having an intra-articular step deformity, 14 of 29 (49%) hips as having an osteochondral lesion, and 27 of 29 (93%) hips as having a labral tear. Plain radiographs and CT scans yielded low sensitivity when compared with arthroscopy for the identification of loose bodies and step deformities. MRI/MRA comparison with arthroscopic findings suggest that MRI/MRA is an accurate tool for identification of labral tears, because 91% of tears seen on arthroscopy were also identified by MRI/MRA. In 4 hips, however, MRI/MRA failed to identify osteochondral lesions that were subsequently identified by arthroscopy. Traumatic injuries of the hip result in substantial intra-articular pathologic findings, including loose bodies, labral tears, step deformities, and osteochondral lesions. The arthroscope is a powerful tool in identifying these injuries. Plain radiographs and CT scans appear to underestimate the true incidence of loose bodies and step deformities within the joint when

  3. Intra-articular fibroma of tendon sheath in a knee joint associated with iliotibial band friction syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Ha, Dong Ho; Choi, Sun Seob; Kim, Soo Jin; Lih, Wang [Dong-A University Medical Center, Busan (Korea, Republic of)

    2015-02-15

    Iliotibial band (ITB) friction syndrome is a common overuse injury typically seen in the active athlete population. A nodular lesion on the inner side of the ITB as an etiology or an accompanying lesion from friction syndrome has been rarely reported. A 45-year-old male presented with recurrent pain and a movable nodule at the lateral joint area, diagnosed as ITB friction syndrome. The nodule was confirmed as a rare intra-articular fibroma of the tendon sheath (FTS) on the basis of histopathologic findings. We describe the MRI findings, arthroscopic and pathologic features, in this case of intra-articular FTS presenting with ITB friction syndrome.

  4. Intra-articular fibroma of tendon sheath in a knee joint associated with iliotibial band friction syndrome

    International Nuclear Information System (INIS)

    Ha, Dong Ho; Choi, Sun Seob; Kim, Soo Jin; Lih, Wang

    2015-01-01

    Iliotibial band (ITB) friction syndrome is a common overuse injury typically seen in the active athlete population. A nodular lesion on the inner side of the ITB as an etiology or an accompanying lesion from friction syndrome has been rarely reported. A 45-year-old male presented with recurrent pain and a movable nodule at the lateral joint area, diagnosed as ITB friction syndrome. The nodule was confirmed as a rare intra-articular fibroma of the tendon sheath (FTS) on the basis of histopathologic findings. We describe the MRI findings, arthroscopic and pathologic features, in this case of intra-articular FTS presenting with ITB friction syndrome.

  5. Benzocaine hydrochloride anesthesia in carp (Cyprinus carpio / Cloridrato de benzocaína na anestesia de carpas (Cyprinus carpio

    Directory of Open Access Journals (Sweden)

    Marco Antonio da Rocha

    2008-08-01

    Full Text Available Fish anesthesia is indicated to allow the accomplishment of several procedures such as biometry, tagging, transportation, physical examination, surgical procedures, and reproductive management. The doses of benzocaine in the carp anesthesia (Cyprinus carpio were determined, carrying through six phases with 40 fish each. The average weight of carps in each phase was of 147.45±7.99g, 173.32±9.15g, 191.26±14.05g, 269.84±19.24g, 285.25±17.97g, and 300.91±16.45g. In each phase, fish had been captured and placed in four containers each one with different concentrations of benzocaine (100, 140, 180 and 220 mg/L respectively. The induction time (IT was registered for each fish and after that the anesthetic induction biometry was performed. In each phase the minimal dose of benzocaine was calculated using the Linear Response Plateau (LRP, in a model that included dose and IT. The LRP was calculated for each phase: 125.79mg/L in 114.33s, 155.68mg/L in 115.75s, 145.33mg/L in 102.52s, 149.50mg/L in 140.53s, 166.42mg/L in 116.15s, and 158.34mg/L in 102.00s. The optimal dose was related with the weight, resulting in the equation: dose=114.230+0.158 x weight (r2=0.53. The equation shows that an increase in the weight in 1g corresponds to an increase of 0.158 mg/L in the dose of benzocaine hydrochloride for carps.A anestesia em peixes é indicada para permitir a realização de diversos procedimentos como: biometria, marcação, transporte, exame físico, procedimentos cirúrgicos e manejo reprodutivo. Determinou-se a dose de benzocaína na anestesia de carpas (Cyprinus carpio, com a realização de seis etapas com 40 peixes cada. O peso médio das carpas em cada etapa foi de 147,45±7,99g, 173,32±9,15g, 191,26±14,05g, 269,84±19,24g, 285,25±17,97g, e 300,91±16,45g. Em cada etapa, os peixes foram capturados e colocados em quatro recipientes com benzocaína nas concentrações de 100, 140, 180 e 220 mg/L respectivamente. O tempo de indução (TI foi

  6. Atitudes atuais de anestesiologistas e médicos em especialização com relação à anestesia venosa total Actitudes actuales de anestesiólogos y médicos en especialización con relación a la anestesia venosa total Current attitude of anesthesiologists and anesthesiology residents regarding total intravenous anesthesia

    Directory of Open Access Journals (Sweden)

    Fernando Squeff Nora

    2006-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: No passado, tempo, custos, informações, treinamento e avaliação da profundidade da anestesia limitavam a aceitação da anestesia venosa total (TIVA. O objetivo deste estudo foi determinar atitudes de anestesiologistas e médicos em especialização com relação à anestesia venosa total. MÉTODO: Um questionário foi enviado a 150 anestesiologistas e 102 residentes. A concordância (C e discordância (D em cada item foram comparadas por testes z (consenso, se p JUSTIFICATIVA Y OBJETIVOS: Antiguamente, tiempo, costes, informaciones, capacitación y evaluación de la profundidad de la anestesia limitaban la aceptación de la anestesia venosa total (TIVA. El objetivo de este estudio fue el de determinar las actitudes de anestesiólogos y médicos en especialización con relación a la anestesia venosa total. MÉTODO: Un cuestionario fue enviado a 150 anestesiólogos y 102 residentes. La concordancia (C y discordancia (D en cada ítem se compararon por pruebas z (consenso, si p BACKGROUND AND OBJECTIVES: In the past, time, cost, information, training, and the evaluation of the plane of anesthesia limited the acceptance of total intravenous anesthesia (TIVA. The objective of this study was to determine the attitude of anesthesiologists and other anesthesiology residents regarding total intravenous anesthesia. METHODS: A questionnaire was sent to 150 anesthesiologists and 102 residents. The concordance (C and disaccord (D of each item were compared by z tests (consensus if p < 0.05. RESULTS: There were 98 responses. The data represent the number of answers for each category. The majority of the participants agreed that the quality of the awakening stimulates the use of the TIVA (C/D = 86/8; p < 0.05; that the future depends on the development of drugs with a fast onset of action and immediate recovery (C/D = 88/5; p < 0.05; that they would like to use TIVA more often (C/D = 72/21; p < 0.05; and to have more information

  7. Intraarticular Injections of Platelet-rich Plasma (PRPin the Management of Knee Osteoarthritis

    Directory of Open Access Journals (Sweden)

    E. Carlos Rodriguez-Merchan

    2013-09-01

    Full Text Available   The clinical use of PRP therapy in the practical setting of orthopaedic fields is increasing partly because of the accessibility of devices that are used in outpatient preparation and delivery. Another reason is the strong advertisement of PRP procedures as the ultimate treatment and novel technology for knee problems by a few orthopaedic surgeons based on claims of abundant scientific evidence. Hence, PubMed articles related to the clinical use of PRP in knee osteoarthritis were searched using the key words: PRP, knee and osteoarthritis in order to study these claims. A total of 20 reports were found directly related to the topic. The aforementioned clinical studies suggest that intraarticular injections of PRP could have preventive effects against osteoarthritis progression. However, presently there is no clear evidence from well-designed clinical trials that intraarticular injections of PRP are efficacious in osteoarthritis. Therefore, at this time the efficacy of PRP requires more investigation, wherein better scientific studies should be performed that include high powered randomized controlled trials.

  8. Intraarticular injection autologous platelet-rich plasma and bone marrow concentrate in a goat osteoarthritis model.

    Science.gov (United States)

    Wang, Zhen; Zhai, Chenjun; Fei, Hao; Hu, Junzheng; Cui, Weiding; Wang, Zhen; Li, Zeng; Fan, Weimin

    2018-02-21

    To evaluate the effects of intraarticular injections of autologous platelet-rich plasma (PRP) or bone marrow concentrate (BMC) on osteoarthritis (OA), 24 adult goats were equally divided into control (Ctrl), saline (NS), PRP, and BMC groups, and OA was induced by surgery in NS, PRP, and BMC groups. Autologous PRP and BMC were obtained from whole blood and bone marrow aspirates, respectively. The data revealed, platelets were increased in BMC by 1.8-fold, monocytes by 5.6-fold, TGF-β1 by 7.7-fold, and IGF-1 by 3.6-fold (p BMC were administered by intraarticular injection once every 4 weeks, three consecutive times. After the animals were sacrificed, inflammatory cytokines in the synovial fluid was measured, and bone and cartilage degeneration progression was observed by macroscopy, histology, and immunohistochemistry. Compared with the NS group, the level of inflammatory cytokines was reduced in the PRP and BMC groups (p BMC treated groups (p BMC group showed greater cartilage protection and less ECM loss than the PRP group (p BMC has therapeutic efficacy in a goat osteoarthritis model, with the greater benefit in terms of cartilage protection being observed in the BMC-treated group than PRP. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  9. Prognostic factors after intra-articular hyaluronic acid injection in ankle osteoarthritis.

    Science.gov (United States)

    Han, Seung Hwan; Park, Do Young; Kim, Tae Hun

    2014-07-01

    The goal of this study was to identify baseline prognostic factors of outcome in ankle osteoarthritis patients after intra-articular hyaluronic acid injection. Patients with ankle osteoarthritis who received hyaluronic acid injection therapy were retrospectively reviewed. Each patient received weekly intra-articular hyaluronic acid injections (2 mL) for 3 weeks. Six predictors including gender, age, symptom duration, radiographic osteoarthritis stage, radiographic subchondral cyst, and fracture history were evaluated. Visual analogue scale (VAS) and patient satisfaction were evaluated as outcome measures. These predictors and outcome measurements were included in a logistic regression model for statistical analysis. Total of 40 consecutive patients (21 male, 19 female) were included in this study. Mean age was 60.6. Average follow up period was 13 months. The mean VAS recorded 3, 6, and 12 months after the first injection was 3.6 (SD 2.54, phyaluronic acid injection for ankle osteoarthritis is a safe and effective treatment, careful selection of patients should be made according to the above prognostic predictors.

  10. Efficacy of Intra-Articular Injection of Hyaluronic Acid in the Treatment of Knee Osteoarthritis

    Directory of Open Access Journals (Sweden)

    SS Narayanan

    2009-05-01

    Full Text Available This study was conducted to evaluate the efficacy of intra- articular injection of hyaluronic acid for the treatment of knee osteoarthritis. Patients with knee osteoarthritis were followed for a period of six months to assess the efficacy of intra-articular injection of hyaluronic acid given three times in three consecutive weeks. Fifty patients were reviewed at two, eight and 24 weeks post-injection. The average age was 60.9 years and female to male ratio was 3:1. Patients were assessed using the Lequesne Algofunctional Index for function, and the visual analogue score for pain and side effects. We found that the knee pain reduced and the function improved in most patients and these beneficial effects maintain till the last follow up. The only side effect noted was one case of acute non-septic joint effusion after the 3rd injection. We concluded that intra-articular injection of hyaluronic acid can produce pain relief and functional improvement for up to 6 months.

  11. Intraarticular calcaneal fractures. Clinical results and functional analysis of the surgical treatment

    International Nuclear Information System (INIS)

    Calixto B, Luis Fernando; Gomez R, Jairo Fernando; Prieto S, Hernan Augusto

    2004-01-01

    This study evaluated the clinical and functional outcome of open reduction and internal fixation in intraarticular calcaneal fractures 22 patients with 24 intra-articular fractures of calcaneous were treated, 19 with open reduction and internal fixation using a 3.5 mm AO/ASIF calcaneal plate. The fractures were classified according the Sanders tomographic system. The Bohler angle was measured before and after the surgery. All patients were evaluated using the functional ankle-hind foot AOFAS scale (American Orthopaedics Foot and Ankle Society) 6 and 12 months after the surgery. Mean age was 39.8 years. The distribution according the type of fracture was: Sanders II: 41.67% and Sanders III: 58.33%. The mean value of the initial Bohler angle was 11.45% and the final was 24.5 degrees. The functional outcome after 6 months was 70 points and after 12 months was 82 points. There were only two complications (12.5%) a fistula and a wound dehiscence. The displaced and slightly comminuted intra articular fractures have the calcaneus (Sandres II and Sandres III) benefit of ORIF obtaining good functional outcomes 6 and 12 months after surgery. This procedure allows a better articular surface reduction, a satisfactory Bohler angle correction and earlier rehabilitation

  12. Virtual MR arthroscopy of the wrist joint: a new intraarticular perspective

    International Nuclear Information System (INIS)

    Sahin, Guelden; Dogan, Basak Erguvan; Demirtas, Mehmet

    2004-01-01

    The aim of this study is to investigate whether virtual MR arthroscopy could be used to visualize the internal architecture of the radiocarpal compartment of the wrist joint in comparison to surgical arthroscopy. Diluted paramagnetic contrast material was injected into the radiocarpal compartment prior to MR examination in all patients. A fat-suppressed T1-weighted three-dimensional fast spoiled gradient echo sequence was acquired in addition to our standard MR imaging protocol in each patient. Three-dimensional data sets were then transferred to an independent workstation and were postprocessed using navigator software to generate surface rendered virtual MR arthroscopic images. Nineteen patients referred for chronic ulnar-sided wrist pain were evaluated with conventional MR arthrography prospectively. Virtual MR arthroscopic images demonstrating the triangular fibrocartilage complex (TFCC) in an intraarticular perspective were achieved in 12 out of 19 patients. Our preliminary investigation suggests that although it has several limitations, virtual MR arthroscopy shows promise in visualizing the TFCC from an intraarticular perspective. (orig.)

  13. Effect of Intra-articular Hyaluronic Acid Injection on Hemiplegic Shoulder Pain After Stroke.

    Science.gov (United States)

    Jang, Myung Hun; Lee, Chang-Hyung; Shin, Yong-Il; Kim, Soo-Yeon; Huh, Sung Chul

    2016-10-01

    To evaluate the efficacy of intra-articular hyaluronic acid (IAHA) injection for hemiplegic shoulder pain (HSP) after stroke. Thirty-one patients with HSP and limited range of motion (ROM) without spasticity of upper extremity were recruited. All subjects were randomly allocated to group A (n=15) for three weekly IAHA injection or group B (n=16) for a single intra-articular steroid (IAS) injection. All injections were administered by an expert physician until the 8th week using a posterior ultrasonography-guided approach. Shoulder joint pain was measured using the Wong-Baker Scale (WBS), while passive ROM was measured in the supine position by an expert physician. There were no significant intergroup differences in WBS or ROM at the 8th week. Improvements in forward flexion and external rotation were observed from the 4th week in the IAHA group and the 8th week in the IAS group. Subjects experienced a statistically significant improvement in pain from the 1st week in the IAS and from the 8th week in IAHA group, respectively. IAHA seems to have a less potent ability to reduce movement pain compared to steroid in the early period. However, there was no statistically significant intergroup difference in WBS and ROM improvements at the 8th week. IAHA might be a good alternative to steroid for managing HSP when the use of steroid is limited.

  14. Usefulness of intra-articular botulinum toxin injections. A systematic review.

    Science.gov (United States)

    Khenioui, Hichem; Houvenagel, Eric; Catanzariti, Jean François; Guyot, Marc Alexandre; Agnani, Olivier; Donze, Cécile

    2016-03-01

    Botulinum toxin is a proven and widely used treatment for numerous conditions characterized by excessive muscular contractions. Recent studies have assessed the analgesic effect of botulinum toxin in joint pain and started to unravel its mechanisms. We searched the international literature via the Medline database using the term "intraarticular botulinum toxin injection" combined with any of the following terms: "knee", "ankle", "shoulder", "osteoarthritis", "adhesive capsulitis of the shoulder". Of 16 selected articles about intraarticular botulinum toxin injections, 7 were randomized controlled trials done in patients with osteoarthritis, adhesive capsulitis of the shoulder, or chronic pain after joint replacement surgery. Proof of anti-nociceptive effects was obtained in some of these indications and the safety and tolerance profile was satisfactory. The studies are heterogeneous. The comparator was usually a glucocorticoid or a placebo; a single study used hyaluronic acid. Pain intensity was the primary outcome measure. The number of randomized trials and sample sizes are too small to provide a satisfactory level of scientific evidence or statistical power. Unanswered issues include the effective dosage and the optimal dilution and injection modalities of botulinum toxin. Copyright © 2015 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

  15. Doença de Moyamoya e anestesia com sevoflurano fora do centro cirúrgico: relato de caso Enfermedad de Moyamoya y anestesia con sevoflurano fuera del centro quirúrgico: relato de caso Moyamoya disease and sevoflurane anesthesia outside the surgery center: case report

    OpenAIRE

    Sheila Braga Machado; Florentino Fernandes Mendes; Adriana de Campos Angelini

    2002-01-01

    JUSTIFICATIVA E OBJETIVOS: A doença de Moyamoya é uma desordem cerebrovascular progressiva que representa um desafio anestésico em virtude da precária circulação cerebral destes pacientes, constituindo-se numa importante causa de acidente vascular cerebral em indivíduos jovens. O objetivo deste relato é apresentar o caso de um paciente com doença de Moyamoya que foi submetido à anestesia geral com sevoflurano para procedimento diagnóstico fora do centro cirúrgico. RELATO DO CASO: Criança com ...

  16. Anestesia venosa total (AVT) em lactente com doença de Werdnig-Hoffmann: relato de caso Anestesia general intravenosa (AVT) en lactante con enfermedad de Werdnig-Hoffmann: relato de caso Total intravenous anesthesia (TIVA) in an infant with Werdnig-Hoffmann disease: case report

    OpenAIRE

    Marco Antonio Cardoso de Resende; Elizabeth Vaz da Silva; Osvaldo José Moreira Nascimento; Alberto Esteves Gemal; Giseli Quintanilha; Eliana Maria Vasconcelos

    2010-01-01

    JUSTIFICATIVA E OBJETIVOS: A doença de Werdnig-Hoffmann é a causa mais comum de hipotonia no lactente e quando presente logo após o nascimento tem pior prognóstico. Fraqueza muscular simétrica, arreflexia e fasciculações da língua são característicos. A maioria dos lactentes morre antes dos dois anos por insuficiência respiratória. O presente relato apresenta um caso com técnica venosa total durante anestesia. RELATO DO CASO: Paciente feminina, branca, um ano, 10 kg, estado físico ASA III, co...

  17. O tempo e a anestesia obstétrica: da cosmologia caótica à cronobiologia El tiempo y la anestesia obstétrica: de la cosmología caótica a la cronobiología Time and obstetric anesthesia: from chaotic cosmology to chronobiology

    Directory of Open Access Journals (Sweden)

    Nilton Bezerra do Vale

    2009-10-01

    /morir, etc., y las condiciones ambientales (sincronizadores, influyen en la fisiología del parto en función de la existencia de relojes endógenos (osciladores, que interactúan con pistas sociales diuturnas. En esta revisión, fueron abordados los parámetros anestésico-obstétricos cíclicos más importantes en la atención a la parturiente. CONTENIDO: Análisis cronobiológico de los principales eventos de la fisiopatología obstétrica de la Mulier sapiens: I Período de la embriogénesis y riesgo de teratogénesis; II de la prematuridad al postdatismo: del parto eutócico al cerclaje uterino; III La noche y el parto: mayor incidencia nocturna del parto (facilitación fisiológica, y diurna de la cesárea (opción del obstetra; IV La luna y el parto (resultado no conclusivo; V guardia nocturna en la Anestesia Obstétrica: contingencia profesional de más riesgos; VI Tiempos de la cesárea: retirada fetal: tiempo UD (uterotomy - delivery, el más corto posible; corrección eficaz de la hipotensión arterial y valorización del tiempo de ayuno preanestésico; VII Variación circadiana de la distocia: dolor; contracción uterina; pérdida sanguínea; hipertensión arterial sistémica (HAS; riesgo de alergia y asma brónquica. En la fase nocturna, existe una mayor intensidad de contracción y más riesgos de hemorragia, de alergia y de asma. En contraposición, hay una falta de variación circadiana de la HAS en la eclampsia; VIII Cronofarmacología obstétrica: anestésicos locales, analgésicos, hipnóticos, anestésicos generales y bloqueadores neuromusculares. La cronergia explica el pico analgésico matinal de los opioides, el vespertino de los anestésicos locales y el nocturno de los anestésicos generales inhalatorios. CONCLUSIONES: El abordaje cronobiológico de la atención anestésica al parto en la maternidad, enfatiza la importancia obstétrica del ritmo circadiano en la humanización y seguridad del parto.BACKGROUND AND OBJECTIVES: Temporal cycles (dark

  18. The use of local anesthesia and sedation in transanal hemorrhoidal dearterialization with Doppler

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    Fernanda Bellotti Formiga

    2018-04-01

    Full Text Available The treatment of hemorrhoidal disease has never been as innovated as in recent decades. The transanal hemorrhoidal dearterialization with Doppler (THD was described under general anesthesia or spinal blockage and there is no use of local anesthesia reports. This study aims to evaluate the safety of the use of local anesthesia with sedation in THD. For this purpose, two cases are reported describing the technical and safety analysis and results. Both patients were women with grade II and III hemorrhoidal disease. These patients underwent pre-anesthetic sedation with intravenous diazepam, then were positioned in lithotomy and sedated with midazolam and pethidine. The intersphincteric blockage was followed by THD with mucopexy. One patient made a small submucosal hematoma without expansion. The patients were stable and comfortable throughout the procedure. Both were discharged the next day, with regular analgesia. In the seventh postoperative day, both had mild annoyance at constant tenesmus, which was reduced gradually. The cases illustrate that THD is feasible when performed with local anesthesia and sedation, as it is safe and effective. This new technology can be incorporated into services that have a local anesthesia protocol as their standard. Resumo: O tratamento da doença hemorroidária nunca foi tão inovado como nas últimas décadas. A desarterialização hemorroidária transanal é uma dessas inovações. Foi originalmente descrita sob anestesia geral ou bloqueio espinal e não há relatos de utilização de anestesia local. Assim, este estudo visa avaliar a segurança do uso da anestesia local com sedação na desarterialização hemorroidária transanal. Para tal, dois casos são relatados com descrição da técnica e análise da segurança e resultados. Ambas pacientes eram mulheres com doença hemorroidária grau II e III. Foram submetidas à indução anestésica, posicionadas em litotomia e sedadas com midazolan e petidina

  19. NEUROCIENCIA Y ANESTESIA

    OpenAIRE

    Antonello Penna S., Dr., MD, PhD; Rodrigo Gutiérrez R., Dr., MD PhD(c)

    2017-01-01

    RESUMEN: Uno de los focos principales de la neurociencia es entender las funciones cerebrales superiores y cómo estas son inhibidas de manera reversible por los anestésicos generales. Por ello, la comprensión del mecanismo de acción de estos fármacos, que rutinariamente se utilizan en la práctica clínica, ha permitido avanzar enormemente en entender cómo se integra la información a nivel cerebral para establecer las nuevas memorias, la capacidad de reaccionar al medio externo y las bases de l...

  20. Quimioterapia e anestesia

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    Márcio Augusto Lacerda

    2001-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A quimioterapia é um dos principais tipos de tratamento oferecido a pacientes com câncer, mas ainda causam importantes efeitos colaterais, reversíveis ou não. Para os anestesiologistas, conhecer estas drogas, complicações e interações medicamentosas, é de importância capital em cirurgias com pacientes em tratamento de neoplasias. CONTEÚDO: Nesta revisão apresentam-se os diferentes tipos de quimioterápicos atualmente utilizados, a classificação farmacológica, repercussões orgânicas, interações com outras substâncias, e a conduta anestésica mais apropriada frente a elas, objetivando reduzir a morbi-mortalidade perioperatória nestes pacientes. CONCLUSÕES: O conhecimento, pelo anestesiologista, das formas de tratamento, das características farmacológicas destas substâncias, seus efeitos adversos, lesões estruturais e possíveis interações medicamentosas por elas geradas e potencializadas pelas várias técnicas anestésicas hoje empregadas, pode certamente reduzir a morbi-mortalidade peri-operatória destes pacientes.

  1. Comparison of peri- and intraarticular analgesia with femoral nerve block after total knee arthroplasty: a randomized clinical trial

    DEFF Research Database (Denmark)

    Toftdahl, Karen; Nikolajsen, Lone; Haraldsted, Viggo

    2007-01-01

    to receive continuous femoral nerve block (group F) or peri- and intraarticular infiltration and injection (group I). Group I received a solution of 300 mg ropivacaine, 30 mg ketorolac, and 0.5 mg epinephrine by infiltration of the knee at the end of surgery, and 2 postoperative injections...

  2. Are intra-articular injections of hyaluronic acid effective for the treatment of temporomandibular disorders? A systematic review.

    Science.gov (United States)

    Goiato, M C; da Silva, E V F; de Medeiros, R A; Túrcio, K H L; Dos Santos, D M

    2016-12-01

    This systematic review aimed to investigate whether intra-articular injections of hyaluronic acid (HA) are better than other drugs used in temporomandibular joint arthrocentesis, for the improvement of temporomandibular disorder (TMD) symptoms. Two independent reviewers performed an electronic search of the MEDLINE and Web of Science databases for relevant studies published in English up to March 2016. The key words used included a combination of 'hyaluronic acid', 'viscosupplementation', 'intra-articular injections', 'corticosteroids', or 'non steroidal anti inflammatory agents' with 'temporomandibular disorder'. Selected studies were randomized clinical trials and prospective or retrospective studies that primarily investigated the application of HA injections compared to other intra-articular medications for the treatment of TMD. The initial screening yielded 523 articles. After evaluation of the titles and abstracts, eight were selected. Full texts of these articles were accessed and all fulfilled the inclusion criteria. Intra-articular injections of HA are beneficial in improving the pain and/or functional symptoms of TMDs. However, other drug therapies, such as corticosteroid and non-steroidal anti-inflammatory drug injections, can be used with satisfactory results. Well-designed clinical studies are necessary to identify an adequate protocol, the number of sessions needed, and the appropriate molecular weight of HA for use. Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  3. Pain from intra-articular NGF or joint injury in the rat requires contributions from peptidergic joint afferents.

    Science.gov (United States)

    Kras, Jeffrey V; Weisshaar, Christine L; Pall, Parul S; Winkelstein, Beth A

    2015-09-14

    Non-physiological stretch of the cervical facet joint's capsular ligament induces persistent behavioral hypersensitivity and spinal neuronal hyperexcitability via an intra-articular NGF-dependent mechanism. Although that ligament is innervated by nociceptors, it is unknown if a subpopulation is exclusively responsible for the behavioral and spinal neuronal responses to intra-articular NGF and/or facet joint injury. This study ablated joint afferents using the neurotoxin saporin targeted to neurons involved in either peptidergic ([Sar(9),Met (O2)(11)]-substance P-saporin (SSP-Sap)) or non-peptidergic (isolectin B4-saporin (IB4-Sap)) signaling to investigate the contributions of those neuronal populations to facet-mediated pain. SSP-Sap, but not IB4-Sap, injected into the bilateral C6/C7 facet joints 14 days prior to an intra- articular NGF injection prevents NGF-induced mechanical and thermal hypersensitivity in the forepaws. Similarly, only SSP- Sap prevents the increase in mechanical forepaw stimulation- induced firing of spinal neurons after intra-articular NGF. In addition, intra-articular SSP-Sap prevents both behavioral hypersensitivity and upregulation of NGF in the dorsal root ganglion after a facet joint distraction that normally induces pain. These findings collectively suggest that disruption of peptidergic signaling within the joint may be a potential treatment for facet pain, as well as other painful joint conditions associated with elevated NGF, such as osteoarthritis. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  4. Is intraarticular administration of tranexamic acid better than its intravenous administration in reducing blood loss after total knee arthroplasty?

    Directory of Open Access Journals (Sweden)

    Ameet Pispati

    2013-01-01

    Full Text Available Context: It has been well-established now that intravenous (IV tranexamic acid (TXA is a potent agent to control postoperative blood loss following total knee arthroplasty (TKA. Recently, intraarticular administration of this agent has also shown good efficacy for the same. Aims: Comparison of postoperative blood loss between IV and topical administration of TXA in TKAs. Materials and Design: Eighty-six TKAs on knees were included in this study. Randomization was done so that 40 TKA received 1 g of IV TXA, while 46 had intraarticular administration of 1 g TXA. Subjets and Methods: We compared the postoperative blood loss by calculating the difference in pre- and postop hemoglobin and need for blood transfusion. Functional assessment was done on basis of Western Ontario McMaster Osteo-Arthritis Index (WOMAC scores and complications like postoperative infection, oozing from the wound site and thromboembolic manifestations. Results: Blood loss was significantly less in the intraarticular administration group as compared to the IV injection group. Total blood loss, blood transfusion group, and drain output was also less but the difference was not significant. The functional assessment (WOMAC scores were equivocal and so were the complications including thromboembolic manifestations (two cases each of deep vein thrombosis (DVT and no cases of pulmonary embolism (PE. Conclusion: Intraarticular administration of TXA to prevent postoperative blood loss in TKA is a safe and effective alternative/adjunct to its IV administration.

  5. Intra-articular fibrous band of the ankle: an uncommon cause of post-traumatic ankle pain

    International Nuclear Information System (INIS)

    Slavotinek, J.P.; Martin, D.K.

    2006-01-01

    A case of an intra-articular fibrous band of the ankle is presented with emphasis on the MR imaging appearances. This entity is an important but uncommon cause of post-traumatic ankle pain and is well recognized within the arthroscopy literature, but there is little if any documentation of this condition in the imaging literature

  6. Body mass index and active range of motion exercise treatment after intra-articular injection in adhesive capsulitis

    Directory of Open Access Journals (Sweden)

    Hsi-Hsien Lin

    2013-04-01

    Conclusion: Active range of motion exercise after an intra-articular injection of corticosteroid and lidocaine improved pain and functional outcome at 8 weeks in normal-weight (BMI < 25 kg/m2 patients with primary adhesive capsulitis. Manipulation under anesthesia may be considered a priority in overweight patients.

  7. A protocol for developing a clinical practice guideline for intra-articular injection for treating knee osteoarthritis

    Directory of Open Access Journals (Sweden)

    Dan Xing

    2018-01-01

    Ethics and dissemination: The protocol will provide us a roadmap to systematically develop evidence-based CPG for intra-articular injection for knee OA. The work will be disseminated electronically and in print. The guideline would be the first CPG that is developed primarily by orthopedic specialists in China and strictly based on systematic methodology.

  8. MR imaging of the knee joint plain, after intraarticular administration of gadolinium DTPA, common salt and air

    International Nuclear Information System (INIS)

    Baum, H.; Kuehnert, A.; Sundermeyer, R.

    1987-01-01

    Noninvasive MRI of the knee joint yields a great deal of information on soft parts (ligaments, capsule, free fluid, menisci, cartilage) and bones. The image is changed by intraarticular administration of air and of small quantities of fluids that supply many signals, such as gadolinium DTPA solution. The results and possibilities of application are discussed. (orig.) [de

  9. Modelo de anestesia em coelhos para procedimentos no tórax Anesthesia model in rabbits for thoracic surgery

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    Elias Kallas

    2001-06-01

    Full Text Available A intubação endotraqueal em coelhos é dificil. O risco anestésico não é desprezível pela estreita margem de segurança entre o plano anestésico e o óbito. Tais fatos despertaram nosso interesse por uma solução simples e segura. Dez animais machos receberam por via intramuscular acepromazina, cetamina e xilazina. Após dez minutos procedeu-se exposição do ligamentum cricothyroideum , o qual foi incisado para colocação de tubo endotraqueal iniciando-se a administração de oxigênio e halotano. A punção arterial foi realizada para controle da pressão arterial média. Procedeu-se toracotomia no quinto espaço intercostal esquerdo com biópsia do pulmão e colabamento pulmonar, iniciando-se a ventilação seletiva do pulmão contra-lateral. Amostras sangüíneas, para medida do pH, foram colhidas no início do procedimento, após o colabamento pulmonar e no final, antes da expansão do pulmão, 30 minutos após o colabamento. Fechado o tórax, foi retirado o tubo endotraqueal tão logo o animal apresentasse recuperação dos reflexos e a seguir suturado ligamentum cricothyroideum. Os animais foram submetidos a eutanásia 14 dias após, quando procedeu-se a nova biópsia pulmonar, a retirada da traquéia e da laringe, para exame. Concluiu-se que este é um procedimento simples e seguro de anestesia para cirurgia torácica em coelhos.The endotracheal intubation of rabbits is difficult. The anesthetic risk is high because of the narrow difference between the effective and the lethal dose. We used a safe and simple method. Ten male animals received intramuscular injection of acepromazine, cetamine, and xylazine. Ten minutes later, an endotracheal canula was inserted trough a small cervical incision on the crico-tyroid membrane, to administrate oxigen and halothane. Thoracotomy was performed in the 5th. left intercostal space and a pulmonary biopsy too. The left lung collapsed and ventilation of the right lung remained for the next 30

  10. Anestesia para el tratamiento intraparto extraútero (EXIT) en fetos con diagnóstico prenatal de malformaciones cervical y oral: relato de casos

    OpenAIRE

    Helfer, Daniel Corrêa [UNIFESP; Clivatti, Jefferson [UNIFESP; Yamashita, Américo Massafuni [UNIFESP; Moron, Antonio Fernandes [UNIFESP

    2012-01-01

    JUSTIFICATIVA E OBJETIVOS: O feto com diagnóstico pré-natal de massa cervical, ou qualquer outra doença que obstrua as vias aéreas, não deve ser abordado de forma convencional por apresentar dois desafios ao médico assistente logo após o parto: o tempo limitado para se estabelecer o acesso a vias aéreas potencialmente difíceis e a ausência de anestesia do neonato caso seja necessária instrumentação das vias aéreas. O procedimento EXIT (ex utero intrapartum treatment - EXIT procedure) consiste...

  11. Anestesia epidural com associação medetomidina e lidocaína, em gatos pré-medicados com acepromazina e midazolam

    Directory of Open Access Journals (Sweden)

    D.A.S.D. Lima

    2011-04-01

    Full Text Available Avaliaram-se os efeitos anestésicos promovidos pela associação medetomidina e lidocaína por via epidural, em gatos pré-tratados com acepromazina e midazolam. Foram utilizados 10 gatos adultos, machos e fêmeas, hígidos e com média de peso de 2,5±0,6kg, distribuídos em dois grupos (GM e GL de igual número (n=5. Administraram-se, como medicação pré-anestésica, acepromazina, 0,2mg/kg, e midazolam, 0,5mg/kg, via intramuscular, e 20 minutos depois, nos animais do GM, por via epidural, lidocaína, 4,4mg/kg, associada à medetomidina, 0,02mg/kg. Os gatos do GL receberam lidocaína, 4,4mg/kg, associada à solução de NaCl a 0,9%. As avaliações ocorreram antes da pré-anestesia (MPA, 20 minutos após a MPA e antes da anestesia epidural, e aos 10, 20, 30 e 40 minutos após a anestesia epidural, respectivamente, T-20, T0, T10, T20, T30 e T40. Foram avaliados: frequência cardíaca (FC e respiratória (FR, temperatura do corpo, saturação de oxiemoglobina, analgesia, miorrelaxamento e período de recuperação. No GM, a FC diminuiu em T20, T30 e T40 em relação ao T-20 e T10 e foi mais baixa que a FC do GL em T20, T30 e T40, respectivamente, 86, 91 e 88 bat/min e 194, 205 e 177 bat/min. A FR variou entre o T-20 e os outros momentos de avaliação nos animais do GL. Nas variáveis eletrocardiográficas, houve diferenças entre T20, T30 e T40 e T-20 e T0, valores de 235, 238 e 240ms e 156 e 161ms, respectivamente, somente no GM. Este grupo diferiu do GL nas avaliações em T20, T30 e T40, valores de 147, 132 e 150ms para os gatos do GL. Oitenta por cento dos gatos tiveram analgesia intensa, e em todos os animais ocorreu relaxamento da mandíbula e da língua. O tempo de recuperação foi de 40 e 15min no GM e no GL, respectivamente. Concluiu-se que a associação lidocaína com medetomidina promoveu plano anestésico estável com grau de anestesia e recuperação anestésica de boa qualidade.

  12. Anestesia por isofluorano em eqüinos submetidos à infusão contínua de medetomidina ou xilazina

    OpenAIRE

    Dória,Renata Gebara Sampaio; Valadão,Carlos Augusto Araújo; Canola,Paulo Aléscio; Guirro,Érica Cristina Bueno do Prado; Mendes,Marina Ceccato; Escobar,André; Ribeiro,Gesiane; Natalini,Cláudio Côrrea

    2009-01-01

    Avaliaram-se oito eqüinos sob anestesia geral inalatória com isofluorano (1CAM) e infusão contínua de xilazina (0,35mg kg-1h-1) ou medetomidina (3,5µg kg-1h-1), em relação à freqüência cardíaca, ritmo cardíaco, freqüência respiratória, pressão arterial, hemogasometria arterial e temperatura, nos tempos T0 (imediatamente antes do início da infusão contínua) e T10 ao T60 (intervalos de 10 minutos, após início da infusão contínua). Houve redução da freqüência cardíaca e da temperatura e el...

  13. Localized tenosynovial giant cell tumor in both knee joints

    International Nuclear Information System (INIS)

    Kim, Hyun Su; Kwon, Jong Won; Ahn, Jin Hwan; Chang, Moon Jong; Cho, Eun Yoon

    2010-01-01

    Tenosynovial giant cell tumor, previously called pigmented villonodular synovitis (PVNS), is a rare benign neoplastic process that may involve the synovium of the joint. The disorder is usually monoarticular and only a few cases have been reported on polyarticular involvement. Herein, we present a case of localized intra-articular tenosynovial giant cell tumor in a 29-year-old man involving both knee joints with a description of the MR imaging and histological findings. (orig.)

  14. The effects of intra-articular glucocorticoids and exercise on pain and synovitis assessed on static and dynamic magnetic resonance imaging in knee osteoarthritis

    DEFF Research Database (Denmark)

    Riis, R G C; Henriksen, M; Klokker, L

    2017-01-01

    ) investigate if any of the changes in patient reported outcome measures (PROMs) were associated with changes in MRI-measures of synovitis. DESIGN: We performed a randomized, double-blinded, placebo-controlled clinical trial evaluating the effects of intra-articular corticosteroid vs placebo injections given......-articular corticosteroids over intra-articular saline when combined with an exercise program for reduction of synovitis in KOA. The improvement in pain and function following the intervention with intra-articular corticosteroids/saline and exercise could not be explained by a decrease in synovitis on MRI indicating other...... pain causing/relieving mechanisms in KOA....

  15. MRI of the sacroiliac joints in spondyloarthritis: the added value of intra-articular signal changes for a 'positive MRI'.

    Science.gov (United States)

    Laloo, Frederiek; Herregods, N; Jaremko, J L; Verstraete, K; Jans, L

    2018-05-01

    To determine if intra-articular signal changes at the sacroiliac joint space on MRI have added diagnostic value for spondyloarthritis, when compared to bone marrow edema (BME). A retrospective study was performed on the MRIs of sacroiliac joints of 363 patients, aged 16-45 years, clinically suspected of sacroiliitis. BME of the sacroiliac joints was correlated to intra-articular sacroiliac joint MR signal changes: high T1 signal, fluid signal, ankylosis and vacuum phenomenon (VP). These MRI findings were correlated with final clinical diagnosis. Sensitivity (SN), specificity (SP), likelihood ratios (LR), predictive values and post-test probabilities were calculated. BME had SN of 68.9%, SP of 74.0% and LR+ of 2.6 for diagnosis of spondyloarthritis. BME in absence of intra-articular signal changes had a lower SN and LR+ for spondyloarthritis (SN = 20.5%, LR+ 1.4). Concomitant BME and high T1 signal (SP = 97.2%, LR + = 10.5), BME and fluid signal (SP = 98.6%, LR + = 10.3) or BME and ankylosis (SP = 100%) had higher SP and LR+ for spondyloarthritis. Concomitant BME and VP had low LR+ for spondyloarthritis (SP = 91%, LR + =0.9). When BME was absent, intra-articular signal changes were less prevalent, but remained highly specific for spondyloarthritis. Our results suggest that both periarticular and intra-articular MR signal of the sacroiliac joint should be examined to determine whether an MRI is 'positive' or 'not positive' for sacroiliitis associated with spondyloarthritis.

  16. FUNCTIONAL OUTCOME OF INTERNAL FIXATION FOR DISPLACED INTRA-ARTICULAR CALCANEAL FRACTURE

    Directory of Open Access Journals (Sweden)

    Saket Jati

    2016-12-01

    Full Text Available BACKGROUND There are always difference of opinion in the importance of Bohler’s angle in evaluating the severity of displaced intra-articular calcaneal fractures and predicting the functional outcome following surgical fixation. The purpose of this research, the relationship exists between Bohler’s angle and the injury severity of displaced calcaneal fractures and between surgical improvement of Bohler’s angle and its practical outcome. MATERIALS AND METHODS Patients were treated surgically for unilateral closed displaced intra-articular calcaneal fractures from May 2014 to October 2016 were identified. The Bohler’s angles of bilateral calcaneus were measured and was compared to the dimension of the uninjured foot was used as its normal control. The difference in the value of Bohler’s angle measured preoperatively or after surgery between the angle of the damaged foot and that of the contralateral calcaneus was calculated, respectively. The change in Bohler’s angle by ratio was calculated by dividing the variation in the value of Bohler’s angle between bilateral calcaneus by its typical control. The injury severity was assessed according to Sanders classification. The functional outcomes were assessed using American Orthopaedic Foot and Ankle Society hindfoot scores. RESULTS 30 patients were included into the study with a mean follow-up duration of 30 months. According to Sanders classification, the fracture pattern included 12 type II, 10 type III and 8 type IV fractures. According to American Orthopaedic Foot and Ankle Society hindfoot scoring system, the excellent, good, fair and poor results were achieved in 10, 8, 4 and 2 patients, respectively. The preoperative Bohler’s angle, difference value of Bohler’s angle between bilateral calcaneus and change in Bohler’s angle by ratio each has a significant relationship with Sanders classification (P=0.003; P=0.004; P=0.005, respectively, however, is not correlated with

  17. Doença de Moyamoya e anestesia com sevoflurano fora do centro cirúrgico: relato de caso Enfermedad de Moyamoya y anestesia con sevoflurano fuera del centro quirúrgico: relato de caso Moyamoya disease and sevoflurane anesthesia outside the surgery center: case report

    Directory of Open Access Journals (Sweden)

    Sheila Braga Machado

    2002-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A doença de Moyamoya é uma desordem cerebrovascular progressiva que representa um desafio anestésico em virtude da precária circulação cerebral destes pacientes, constituindo-se numa importante causa de acidente vascular cerebral em indivíduos jovens. O objetivo deste relato é apresentar o caso de um paciente com doença de Moyamoya que foi submetido à anestesia geral com sevoflurano para procedimento diagnóstico fora do centro cirúrgico. RELATO DO CASO: Criança com 13 anos, estado físico ASA IV, portadora de doença de Moyamoya com seqüela neurológica após três acidentes vasculares cerebrais, insuficiência renal crônica e hipertensão arterial sistêmica, submetida à endoscopia digestiva alta. Em decúbito dorsal e após monitorização, realizou-se indução inalatória pela cânula de traqueostomia com sevoflurano (aumento gradual da concentração inspiratória até 6% e mistura de oxigênio/óxido nitroso a 50%. Um cateter venoso foi inserido para infusão de solução glicosada a 5%. Foi realizada ventilação controlada manual, sendo a manutenção da anestesia feita com sevoflurano a 4% e mistura de oxigênio/óxido nitroso a 50%. Ao final do procedimento os agentes anestésicos foram descontinuados simultaneamente e foi administrado oxigênio a 100%. A anestesia foi satisfatória, com boa estabilidade hemodinâmica, sem ocorrência de complicações durante o procedimento e com despertar precoce. CONCLUSÕES: O sevoflurano pode oferecer novas perspectivas para a anestesia inalatória em pacientes com doença neurológica que realizam procedimento ambulatorial, já que permite boa estabilidade hemodinâmica e despertar precoce, preservando a fisiologia cerebral.JUSTIFICATIVA Y OBJETIVOS: La enfermedad de Moyamoya es un desorden cerebrovascular progresivo que representa un desafío anestésico en virtud de la precaria circulación cerebral de estos pacientes, constituyéndose una importante

  18. Anestesia para separação de gêmeos isquiópagos no período neonatal: relato de caso Anestesia para separación de gemelos isquiópagos en el período neonatal Anesthetic management for neonatal conjoined twins separation: case report

    Directory of Open Access Journals (Sweden)

    Norma Sueli Pinheiro Módolo

    2002-07-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A separação de gêmeos unidos causa grande interesse devido à complexidade da anestesia e cirurgia, à raridade da patologia e às poucas chances de sobrevida. O objetivo desta descrição é o de contribuir para a literatura existente, relatando os desafios encontrados por nossa equipe no atendimento à cirurgia-anestesia de separação de gêmeos isquiópagos. RELATO DO CASO: Pacientes gêmeos, nascidos a termo, de parto cesariano, pesando juntos 5.100 g, classificados como isquiópagus tetrapus. Duas equipes anestésico-cirúrgicas estavam presentes, sendo o procedimento anestésico esquematizado com aparelho de anestesia, cardioscópio, capnógrafo, oxímetro de pulso, termômetro elétrico, estetoscópio esofágico, todos em dobro. Realizou-se indução anestésica com halotano e fentanil, com os gêmeos em posição lateral e com rotação da cabeça em 45º para facilitar a intubação traqueal. Os recém-nascidos foram mantidos em ventilação controlada manualmente, utilizando o sistema de Rees-Baraka. A anestesia foi mantida com halotano, oxigênio e fentanil. Durante o per-operatório, foram encontrados órgãos abdominais duplos, com exceção do cólon, que era único. As bexigas e os ísquios estavam ligados. Ao final da cirurgia as duas crianças apresentavam-se com sinais vitais estáveis. Os gêmeos permaneceram na Unidade de Terapia Intensiva (UTI Neonatal por quatro semanas e receberam alta em bom estado geral. CONCLUSÕES: Ressalta-se a importância do entrosamento da equipe, do estudo retrospectivo multidisciplinar, da monitorização adequada e acurada observação clínica; todos esses fatores contribuíram para a boa evolução e alta dos gêmeos.JUSTIFICATIVA Y OBJETIVOS: La separación de gemelos unidos causa gran interés debido a la complexidad de la anestesia y cirugía, a la raridad de la patología y a las pocas chances de sobrevida. El objetivo de esta descripción es el de contribuir

  19. In vivo human adipose-derived mesenchymal stem cell tracking after intra-articular delivery in a rat osteoarthritis model

    Directory of Open Access Journals (Sweden)

    Meng Li

    2016-11-01

    Full Text Available Abstract Background Human adipose-derived mesenchymal stem cells (haMSCs have shown efficacy in treating osteoarthritis (OA both preclinically and clinically via intra-articular (IA injection. However, understanding the mode of action of the cell therapy has been limited by cell tracking capability and correlation between the pharmacokinetics of the injected cells and the intended pharmacodynamics effect. This study aims to explore methodology and to understand in vivo biodistribution of clinical-grade haMSCs labeled with fluorescent dye and injected into an immunocompetent OA rat model. Methods haMSCs labeled with fluorescent dye were investigated for their proliferation and differentiation capabilities. Labeled cells were used to establish detection threshold of a noninvasive biofluorescent imaging system before the cells (2.5 × 106 were injected into a conventional rat OA model induced by medial meniscectomy for 8 weeks. We attempted to reveal the existence of labeled cells in vivo by imaging and a molecular biomarker approach, and to correlate with the in vivo efficacy and physical presence over a follow-up period up to 10 weeks. Results In vitro proliferation and differentiation of haMSCs were not affected by the labeling of DiD dye. Detection thresholds of the labeled cells in vitro and in vivo were determined to be 104 and 105 cells, respectively. When 2.5 × 106 haMSCs were injected into the joints of a rat OA model, fluorescent signals (or >105 cells lasted for about 10 weeks in the surgical knee joint at the same time as efficacy was observed. Signals in nonsurgical rats only lasted for 4 weeks. The human MSCs were shown to engraft to the rat joint tissues and were proliferative. Human FOXP2 gene was only detected in the knee joint tissue, suggesting limited biodistribution locally to the joints. Conclusions The current study represents the first attempt to correlate cell therapy efficacy on OA with the physical presence

  20. Efeito da anestesia geral na cognição e na memória do idoso Efecto de la anestesia general en la cognición y memoria del paciente de edad avanzada Effects of general anesthesia in elderly patients’ memory and cognition

    Directory of Open Access Journals (Sweden)

    Régis Borges Aquino

    2004-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A anestesia geral e a função mental têm sido alvo de estudos e considerações, especialmente pelo sentimento de que ela, particularmente em idosos, poderia induzir alterações na cognição e na memória. O objetivo dessa pesquisa foi avaliar o efeito da anestesia geral na cognição e na memória do idoso correlacionando-a ao sexo, à idade e ao tempo de anestesia. MÉTODO: Estudo de coorte controlado realizado em pacientes categorizados em dois grupos de observação: a- anestésico; b- clínicos (controle. As variáveis de desfecho consideradas foram os escores dos testes MiniMental, de Fluência Verbal e de Lembrança Numérica. Anestesia geral com halotano, isoflurano, sevoflurano, tiopental, propofol, etomidato, fentanil alfentanil, succinilcolina atracúrio, pancurônio. Intra-operatório com PaCO2 entre 30 e 45 mmHg e saturação de hemoglobina acima de 90% e tolerância de PA com diminuição até 20% do valor basal. Foram excluídos os pacientes que apresentaram algum evento adverso no intra e pós-operatório. Dados categóricos analisados pelo teste do Qui-quadrado. A comparação inicial entre os grupos no momento basal (pré-anestésico foi realizada pelo t de Student para amostras independentes. Para avaliação do efeito do processo anestésico ao longo do tempo, foi utilizada a Análise de Variância (ANOVA para medidas repetidas. RESULTADOS: No teste do MiniMental os grupos apresentaram comportamento semelhante sendo notado aumento de escores ao longo do tempo. No teste de Fluência Verbal, em ambos os grupos os escores mantiveram-se praticamente inalterados. No teste de Lembrança Numérica o comportamento dos grupos foi muito semelhante ao longo do seguimento sendo que os escores aumentaram em ambos os grupos. CONCLUSÕES: Não foi detectado declínio de cognição ou de memória no pós-operatório de idosos de 60 a 80 anos de ambos os sexos, submetidos à anestesia geral com duração de 3 a

  1. [Cutaneous atrophy and hypopigmentation secondary to intra-articular corticosteroid injection].

    Science.gov (United States)

    Loarte Pasquel, E P; Cabal García, A A

    2014-04-01

    Epicondylitis is the most common disease of the elbow. It is a tendinitis caused, in most cases, by repetitive motion of the forearm extensor muscles, and belongs to the group of occupational diseases that are related to work activity or sport. Intra-articular injections of glucocorticoids are often used by dermatologists, rheumatologists, orthopaedic surgeons, and primary care due to their ease of administration. However, this procedure has potential side effects. There are a limited number of case reports describing atrophy and hypopigmentation of the skin as a side effect. The general indications for glucocorticoid injections are monofocal and multifocal inflammatory disease, multifocal articular or soft tissue disease. It is more often used in more severe monofocal or multifocal inflammation, failure of drug treatment and/or rehabilitatory when other treatments are contraindicated. Copyright © 2012 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  2. Intraocular Pressure Increases After Intraarticular Knee Injection With Triamcinolone but Not Hyaluronic Acid.

    Science.gov (United States)

    Taliaferro, Kevin; Crawford, Alexander; Jabara, Justin; Lynch, Jonathan; Jung, Edward; Zvirbulis, Raimonds; Banka, Trevor

    2018-03-09

    Intraarticular steroid injections are a common first-line therapy for severe osteoarthritis, which affects an estimated 27 million people in the United States. Although topical, oral, intranasal, and inhalational steroids are known to increase intraocular pressure in some patients, the effect of intraarticular steroid injections on intraocular pressure has not been investigated, to the best of our knowledge. If elevated intraocular pressure is sustained for long periods of time or is of sufficient magnitude acutely, permanent loss of the visual field can occur. How does intraocular pressure change 1 week after an intraarticular knee injection either with triamcinolone acetonide or hyaluronic acid? A nonrandomized, nonblinded prospective cohort study was conducted at an outpatient, ambulatory orthopaedic clinic. This study compared intraocular pressure elevation before and 1 week after intraarticular knee injection of triamcinolone acetonide versus hyaluronic acid for management of primary osteoarthritis of the knee. Patients self-selected to be injected in their knee with either triamcinolone acetonide or hyaluronic acid before being informed of the study. The primary endpoint was intraocular pressure elevation of ≥ 7 mm Hg 1 week after injection. This cutoff is determined as the minimum significant pressure change in the ophthalmology literature recognized as an intermediate responder to steroids. Intraocular pressure was measured using a handheld Tono-Pen® applanation device. This device is frequently used in intraocular pressure measurement in clinical and research settings; 10 sequential measurements are obtained and averaged with a confidence interval. Only measurements with a 95% confidence interval were used. Over a 6-month period, a total of 96 patients were approached to enroll in the study. Sixty-two patients out of 96 approached (65%) agreed. Thirty-one (50%) were injected with triamcinolone and 31 (50%) were injected with hyaluronic acid. Patients

  3. Treatment Algorithm for Patients with Non-arthritic Hip Pain, Suspect for an Intraarticular Pathology

    DEFF Research Database (Denmark)

    Jørgensen, Rasmus Wejnold; Dippmann, Christian; Dahl, L

    2016-01-01

    BACKGROUND: The amount of patients referred with longstanding, non-arthritic hip pain is increasing, as are the treatment options. Left untreated hip dysplasia, acetabular retroversion and femoroacetabular impingement (FAI) may lead to osteoarthritis (OA). Finding the right treatment option...... associated with acetabular retroversion described in the literature were the crossover sign, the posterior wall sign and the ischial spine sign, while Wiberg's lateral center-edge angle (CE-angle) together with Leqeusne's acetabular index indicate hip dysplasia. A Tönnis index >2 indicates osteoarthritis...... for the right patient can be challenging in patients with non-arthritic hip pain. PURPOSE: The purpose of this study was to categorize the radiographic findings seen in patients with longstanding hip pain, suspect for an intraarticular pathology, and provide a treatment algorithm allocating a specific treatment...

  4. Technical innovation: digital tomosynthesis of the hip following intra-articular administration of contrast

    International Nuclear Information System (INIS)

    Gazaille, Roland E.; Flynn, Michael J.; Page, Walter; Finley, Sonia; Holsbeeck, Marnix van

    2011-01-01

    To demonstrate the clinical use of digital tomosynthesis in the depiction of labral and chondral pathology in the setting of post-operative CAM-type impingement of the hip following intra-articular administration of dilute iodinated contrast. We present images from a 46 year-old African American female with suspected CAM-type femoroacetabular impingement (FAI) following percutaneous pinning of the right hip for slipped capital femoral epiphysis (SCFE). A partial tear of the labrum and clinically significant acetabular chondral abnormalities were demonstrated with the use of digital tomosynthesis with superb anatomic detail. Digital tomosynthesis can be of great clinical utility and can depict pathology in superb anatomic detail, particularly in situations in which MRI is not available as well as under circumstances in which artifact due to orthopedic hardware is of concern as shown in this case. (orig.)

  5. Minimally-invasive treatment of high velocity intra-articular fractures of the distal tibia.

    LENUS (Irish Health Repository)

    Leonard, M

    2012-02-01

    The pilon fracture is a complex injury. The purpose of this study was to evaluate the outcome of minimally invasive techniques in management of these injuries. This was a prospective study of closed AO type C2 and C3 fractures managed by early (<36 hours) minimally invasive surgical intervention and physiotherapist led rehabilitation. Thirty patients with 32 intra-articular distal tibial fractures were treated by the senior surgeon (GK). Our aim was to record the outcome and all complications with a minimum two year follow-up. There were two superficial wound infections. One patient developed a non-union which required a formal open procedure. Another patient was symptomatic from a palpable plate inferiorly. An excellent AOFAS result was obtained in 83% (20\\/24) of the patients. Early minimally invasive reduction and fixation of complex high velocity pilon fractures gave very satisfactory results at a minimum of two years follow-up.

  6. Effect of intra-articular yttrium-90 on chronic pyrophosphate arthropathy of the knee

    International Nuclear Information System (INIS)

    Doherty, M.; Dieppe, P.A.

    1981-01-01

    Fifteen patients with bilateral, symmetrical chronic pyrophosphate arthropathy of the knee were given intra-articular injections of yttrium-90 (5 mCi) plus steroid (triamcinolone hexacetonide, 20 mg) into one knee, and saline plus steroid into the other (control) knee. Allocation of the 90 Y injection was random and double blind. After 6 months there was significantly less pain, inactivity stiffness, joint-line tenderness, and effusion in the 90 Y-injected knees than in the controls (p 90 Y-injected and control knees in the changes in range of movement (p 90 Y may be of benefit in chronic pyrophosphate arthropathy, a disease for which there is no treatment. The predilection of this condition to affect the knees of the elderly makes such treatment highly suitable because the joint lends itself readily to injection and the procedure carries very few actual or potential risks in this age group. (author)

  7. The Treatment of Joint Pain with Intra-articular Pulsed Radiofrequency.

    Science.gov (United States)

    Schianchi, Pietro M; Sluijter, Menno E; Balogh, Susan E

    2013-09-01

    The intra-articular (IA) application of pulsed radiofrequency (PRF) for pain in small and large joints represents a recent development that has proven to be effective in many cases. We performed a retrospective study of 89 such procedures in 57 consecutive patients with chronic articular pain. The aim of this retrospective study is to evaluate the effectiveness of intraarticular PRF in a group of 57 consecutive patients with chronic joint pain. Patients with intractable joint pain for more than 6 months were treated with IA PRF 40-45V for 10-15 min in small joints and 60V for 15 min in large joints using fluoroscopic confirmation of correct needle position. A total of 28 shoulders, 40 knees, 10 trapezio-metacarpal, and 11 first metatarso-phalangeal joints were treated. Results were evaluated at 1, 2, and 5 months. The procedure was repeated after 1 month in 10 patients with initial suboptimal results. Success was defined as a reduction of pain score by at least 50%. All groups showed significant reductions in pain scores at all three follow-up visits. Success rates were higher in small joints (90% and 82%, respectively) than large ones (64% and 60%, respectively). Interestingly, IA PRF was successful in 6 out of 10 patients who had undergone previous surgery, including 3 with prosthetic joint replacement and in 6 of the 10 repeated procedures. There were no significant adverse effects or complications. IA PRF induced significant pain relief of long duration in a majority of our patients with joint pain. The exact mechanism is unclear, but may be related to the exposure of immune cells to low-strength RF fields, inducing an anti-inflammatory effect. The success rate appears to be highest in small joints. We recommend additional research including control groups to further investigate and clarify this method; our data suggest that it may represent a useful modality in the treatment of arthrogenic pain.

  8. Navigation system for robot-assisted intra-articular lower-limb fracture surgery.

    Science.gov (United States)

    Dagnino, Giulio; Georgilas, Ioannis; Köhler, Paul; Morad, Samir; Atkins, Roger; Dogramadzi, Sanja

    2016-10-01

    In the surgical treatment for lower-leg intra-articular fractures, the fragments have to be positioned and aligned to reconstruct the fractured bone as precisely as possible, to allow the joint to function correctly again. Standard procedures use 2D radiographs to estimate the desired reduction position of bone fragments. However, optimal correction in a 3D space requires 3D imaging. This paper introduces a new navigation system that uses pre-operative planning based on 3D CT data and intra-operative 3D guidance to virtually reduce lower-limb intra-articular fractures. Physical reduction in the fractures is then performed by our robotic system based on the virtual reduction. 3D models of bone fragments are segmented from CT scan. Fragments are pre-operatively visualized on the screen and virtually manipulated by the surgeon through a dedicated GUI to achieve the virtual reduction in the fracture. Intra-operatively, the actual position of the bone fragments is provided by an optical tracker enabling real-time 3D guidance. The motion commands for the robot connected to the bone fragment are generated, and the fracture physically reduced based on the surgeon's virtual reduction. To test the system, four femur models were fractured to obtain four different distal femur fracture types. Each one of them was subsequently reduced 20 times by a surgeon using our system. The navigation system allowed an orthopaedic surgeon to virtually reduce the fracture with a maximum residual positioning error of [Formula: see text] (translational) and [Formula: see text] (rotational). Correspondent physical reductions resulted in an accuracy of 1.03 ± 0.2 mm and [Formula: see text], when the robot reduced the fracture. Experimental outcome demonstrates the accuracy and effectiveness of the proposed navigation system, presenting a fracture reduction accuracy of about 1 mm and [Formula: see text], and meeting the clinical requirements for distal femur fracture reduction procedures.

  9. Management of pain on hallux valgus with percutaneous intra-articular Pulse-Dose Radiofrequency.

    Science.gov (United States)

    Masala, Salvatore; Fiori, Roberto; Calabria, Eros; Raguso, Mario; de Vivo, Dominique; Cuzzolino, Alessandro; Simonetti, Giovanni

    2017-01-01

    The purpose of our study was to investigate the role of intra-articular pulse-dose radiofrequency in management of painful hallux valgus refractory to conservative therapies. Between November 2010 and April 2012, 51 patients (15 male, 36 female) with a median age of 71.4 years were included in our clinical trial. Under fluoroscopic guidance we introduced a 22 gauge 10 cm length cannula by a percutaneous access in the first metatarsophalangeal joint and its tip was placed intra-articularly. After removing the spindle, a radiofrequency needle with a 5 mm active tip was introduced. The following parameters were used: 1200 pulses at high voltage (45 V) with 20 msec duration followed by 480 msec silent phases. A great reduction in pain intensity was documented at 1 week, 1 month and 3 months after procedures. Pain intensity increased between 5 and 8 months after treatments, so we performed a second procedure in all patients between 7 months and 9 months since the first treatment. Also in this case we obtained a great reduction of pain intensity in the first 3 months after the procedure. Pain intensity returned at preprocedural values after 9 months after second procedure. No complications were observed. Our experience shows pulse-dose radiofrequency is a safe, repeatable and effective technique for managing patients with symptomatic hallux valgus in the short and medium term. Pulse-dose radiofrequency may improve pain control and quality of life in patients with hallux valgus refractory to conservative therapies. © 2014 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.

  10. Intra-articular sodium hyaluronate 2 mL versus physiological saline 20 mL versus physiological saline 2 mL for painful knee osteoarthritis

    DEFF Research Database (Denmark)

    Lundsgaard, C; Dufour, N; Fallentin, E

    2008-01-01

    Methodological constraints weaken previous evidence on intra-articular viscosupplementation and physiological saline distention for osteoarthritis. We conducted a randomized, patient- and observer-blind trial to evaluate these interventions in patients with painful knee osteoarthritis.......Methodological constraints weaken previous evidence on intra-articular viscosupplementation and physiological saline distention for osteoarthritis. We conducted a randomized, patient- and observer-blind trial to evaluate these interventions in patients with painful knee osteoarthritis....

  11. Intra-articular viscosupplementation with hylan g-f 20 to treat osteoarthritis of the knee: an evidence-based analysis.

    Science.gov (United States)

    2005-01-01

    randomization, type of control intervention, outcome measures for effectiveness and safety, and length of follow-up. The quality of the studies and level of the evidence was initially scored by one clinical epidemiologist using the Jadad scale and GRADE approach. Level of quality depends on the amount of certainty about the magnitude of effect and is based on study designs, extent of methodological limitations, consistency of results and applicability (i.e. directness) to the Ontario clinical context. The GRADE approach also permits comment on the strength of recommendations resulting from the evidence, based on estimates of the magnitude of effect relative to the magnitude of risk and burden and the level of certainty around these estimates. The quality assessments were subsequently peer-reviewed. The literature search revealed 2 previous health technology assessments, 3 meta-analyses of placebo-controlled trials, 1 Cochrane review and meta-analysis encompassing 18 randomized controlled trials (RCTs) that compared hylan G-F 20 to either placebo or active treatments, 11 RCTs of hylan G-F 20 (all included in the Cochrane review), and 10 observational studies. Given the preponderance of evidence, the Medical Advisory Secretariat's analysis focused on studies with Level 1 evidence of effectiveness (i.e., the meta-analyses of RCTs and the RCTs). Only safety data from the observational studies were included. The authors of the 2 health technology assessments concluded that the data were sparse and poor quality. There was some evidence that hylan G-F 20 delivered a small, clinical benefit at 3 to 6 months after treatment on a magnitude comparable to NSAIDs and intra-articular steroids. Hylan G-F 20 appeared to carry a risk of a local adverse reaction of in the range of 3% to 18% per 100 injections, but there was no apparent risk of a severe adverse event, although the data were limited. Each of the 3 meta-analyses of placebo-controlled trials of intra-articular hyaluronans had only 3

  12. Ropivacaína, articaína ou combinação de ropivacaína e articaína em anestesia peridural para cesariana: estudo randomizado, prospectivo e duplo-cego Ropivacaína, articaína o la combinación de ropivacaína y articaína en la anestesia epidural para cesárea: estudio aleatorio, prospectivo y doble ciego Ropivacaine, articaine or combination of ropivacaine and articaine for epidural anesthesia in cesarean section: a randomized, prospective, double-blinded study

    Directory of Open Access Journals (Sweden)

    Derya Arslan Yurtlu

    2013-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Iniciar a anestesia peridural com anestésicos locais de longa duração consome uma quantidade significativa de tempo, o que pode ser problemático em centros de anestesia obstétrica muito movimentados. Aventamos a hipótese de que uma combinação de articaína e ropivacaína proporcionaria início mais rápido e mesmo uma recuperação precoce das características do bloqueio sensório-motor. MÉTODOS: Sessenta parturientes a termo agendadas para cesariana eletiva foram randomicamente alocadas em três grupos para receber 20 mL de articaína a 2% (Grupo A, 10 mL de articaína a 2% + 10 mL de ropivacaína a 0,75% (Grupo AR ou 20 mL de ropivacaína a 0,75% (Grupo R via cateter peridural. O tempo de início do bloqueio sensorial até T10-T6 e o nível máximo de bloqueio, o tempo para a regressão de dois segmentos do nível máximo de bloqueio sensorial e o tempo de início e duração do bloqueio motor foram todos registrados. A necessidade de analgésicos adicionais, intra- e pós-operatoriamente, também foi registrada. RESULTADOS: Os dados demográficos foram semelhantes. Os tempos de início do bloqueio sensorial até os níveis T10 e T6 foram significativamente menores nos grupos A e AR, em comparação com o Grupo R (p JUSTIFICATIVA Y OBJETIVOS: Iniciar la anestesia epidural con anestésicos locales de larga duración consume una cantidad significativa de tiempo, siendo un problema en los centros de anestesia obstétrica que tienen mucho movimiento. Barajamos la hipótesis de que una combinación de articaína y ropivacaína proporcionaría un inicio más rápido e incluso una rápida recuperación de las características del bloqueo sensitivo motor. MÉTODOS: Sesenta parturientes a término que tenían cita para la cesárea electiva se ubicaron aleatoriamente en tres grupos para recibir 20 mL de articaína al 2% (Grupo A, 10 mL de articaína al 2% + 10 mL de ropivacaína al 0,75% (Grupo AR o 20 mL de ropivaca

  13. Hematoma subdural intracraniano pós-anestesia subaracnóidea: relato de dois casos e revisão de 33 casos da literatura

    Directory of Open Access Journals (Sweden)

    Jane Auxiliadora Amorim

    2010-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Hematoma subdural intracraniano é uma complicação rara pós-anestesia subaracnóidea. Relatamos dois casos de mulheres que desenvolveram hematoma subdural crônico pós-anestesia subaracnóidea, diagnosticados após a evolução clínica prolongada de cefaleia pós-punção dural (CPPD e analisamos outros 33 casos encontrados em revisão da literatura. RELATO DOS CASOS: Nos 35 pacientes (idade entre 20-88 anos, 19 homens, 14 tinham mais de 60 anos (40% sendo 12 (86% homens. A relação se inverte no grupo de pacientes mais jovens (< 60 anos, no qual há duas vezes mais mulheres (14:7. Dois picos de maior incidência foram observados: 30-39 anos (31% e 60-69 anos (29%. O período de tempo decorrido entre o início dos sintomas até o diagnóstico variou entre 4 horas e 29 semanas. Cefaleia foi referida por 26/35 (74,3% casos; alteração do nível de consciência em 14/35 (40,0%; vômitos em 11/35 (31,4%; hemiplegia ou hemiparesia em 8/35 (22,9%; diplopia ou paresia do VI nervo craniano em 5/35 (14,3%; e distúrbio da linguagem em 4/35 (11,4%. Os fatores contribuintes foram: gravidez, múltiplas punções, uso de anticoagulantes, anormalidades vasculares intracranianas e atrofia cerebral. Em 15 casos, não foi citado qualquer fator contribuinte. Quatro em 35 pacientes (11,4% ficaram com sequelas neurológicas e 4/35 (11,4% morreram. CONCLUSÕES: A presença de qualquer um desses sinais ou sintomas mencionados serve de alerta para a possibilidade de ocorrer hematoma subdural intracraniano como complicação da punção dural, principalmente naqueles pacientes que apresentaram CPPD por mais de uma semana, quando uma investigação por neuroimagem se faz necessária.

  14. 18 month observational study on efficacy of intraarticular hyaluronic acid (Hylan G-F 20 injections under ultrasound guidance in hip osteoarthritis

    Directory of Open Access Journals (Sweden)

    Cristiano Padalino

    2011-09-01

    Full Text Available Objective: To evaluate the efficacy and the tolerability of viscosupplementation (VS with hyaluronic acid (Hylan GF 20 in a cohort of 36 patients affected by hip osteoarthritis through a 18 months follow-up. Methods: Viscosupplementation was performed with an anteriorsagittal approach, under ultrasound guidance. 36 patients were administered hyaluronic acid intraarticularly in the hip, with a unique injection of Hylan G-F20, which could be repeated after at least 3 months. Treatment efficacy was assessed by functional index WOMAC, pain evaluation on a visual analogue scale and NSAID consumption. All such parameters were recorded at the time of the first injection and then 3, 6, 9, 12 and 18 months later. Results: Statistically significant reduction of all parameters was observed three months after the injection, and was still maintained at the timepoints 6, 9, 12 and 18 months. No local side effects have been observed, nor systemic complications. Conclusions: Our data show that viscosupplementation is a promising approach for hip osteoarthritis, providing beneficial effects in a long-tern follow up. Yet, the topic deserves further and wider studies, so to define the number of injections to administer and suggest a fit interval between subsequent injections.

  15. Safety and Efficacy of Intra-articular Injection of Platelet-Rich Plasma in Patients With Ankle Osteoarthritis.

    Science.gov (United States)

    Fukawa, Taisuke; Yamaguchi, Satoshi; Akatsu, Yorikazu; Yamamoto, Yohei; Akagi, Ryuichiro; Sasho, Takahisa

    2017-06-01

    An intra-articular injection of platelet-rich plasma (PRP) may be an effective treatment for osteoarthritis (OA). However, its efficacy in ankle OA has not been investigated yet. The purpose of this study was to assess the safety and efficacy of an intra-articular injection of PRP in patients with ankle OA during a 24-week period. Twenty ankles of 20 patients with varus-type ankle OA who received intra-articular injections of PRP were evaluated. PRP was extracted from whole blood by using the double-spin technique. Three injections of 2-mL PRP were administered to the ankle at an interval of 2 weeks under ultrasonographic guidance. Adverse events and efficacy were assessed at 4, 12, and 24 weeks after the last injection. Clinical outcomes were assessed by using the visual analog scale (VAS) for pain, the Japanese Society for Surgery of the Foot (JSSF) ankle/hindfoot scale, and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q). No serious adverse effects were observed during the follow-up period. The VAS and JSSF scale scores significantly decreased from baseline to 4, 12, and 24 weeks after treatment ( P SAFE-Q significantly improved from baseline to 12 weeks after treatment ( P = .04). Overall, the amount of pain reduction was maximal at 12 weeks after the last injection, and the effect was reduced at 24 weeks. The patients with late-stage OA had worse scores in all outcomes than those with early-stage OA. Intra-articular injections of PRP resulted in no serious adverse effects and significantly reduced pain in the patients with ankle OA. PRP treatment can be safe and effective and may be an option in the treatment of ankle OA. Level IV, case series.

  16. Intraarticular application of superparamagnetic nanoparticles and their uptake by synovial membrane-an experimental study in sheep

    Energy Technology Data Exchange (ETDEWEB)

    Schulze, Katja [Musculoskeletal Research Unit, Equine Hospital, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057 Zurich (Switzerland); Koch, Annette [Department of Chemistry and Applied BioSciences, Swiss Federal Institute of Technology Zurich (ETH Zurich), Winterthurerstrasse 190, 8057 Zurich (Switzerland); Schoepf, Bernhard [Musculoskeletal Research Unit, Equine Hospital, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057 Zurich (Switzerland); Petri, Alke [Laboratory of Powder Technology, Swiss Federal Institute of Technology (EPFL), Lausanne (Switzerland); Steitz, Benedikt [Laboratory of Powder Technology, Swiss Federal Institute of Technology (EPFL), Lausanne (Switzerland); Chastellain, Mathieu [Laboratory of Powder Technology, Swiss Federal Institute of Technology (EPFL), Lausanne (Switzerland); Hofmann, Margarethe [MatSearch, Chemin Jean Pavillard 14, 1009 Pully (Switzerland); Hofmann, Heinrich [Laboratory of Powder Technology, Swiss Federal Institute of Technology (EPFL), Lausanne (Switzerland); Rechenberg, Brigitte von [Musculoskeletal Research Unit, Equine Hospital, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057 Zurich (Switzerland)]. E-mail: bvonrechenberg@vetclinics.unizh.ch

    2005-05-15

    A superparamagnetic iron oxide nanoparticle, coated with polyvinyl alcohol (PVA-SPION) and its fluorescently functionalized analogue (amino-PVA-Cy3.5-SPION) were compared in vivo as proof of principle for future use in magnetic drug targeting in inflammatory joint diseases. They were injected either intraarticularly or periarticularly and their uptake by cells of the synovial membrane was evaluated. Uptake was completed in 48 h and was enforced by an extracorporally applied magnet.

  17. Evaluation of intra-articular injection of autologous platelet lysate (PL) in horses with osteoarthritis of the distal interphalangeal joint.

    Science.gov (United States)

    Tyrnenopoulou, Panagiota; Diakakis, Nikolaos; Karayannopoulou, Maria; Savvas, Ioannis; Koliakos, Georgios

    2016-06-01

    Regenerative medicine has become one of the most promising therapies of equine osteoarthritis. Platelet lysate (PL) is rich in bioactive proteins and growth factors that play a crucial role in tissue healing. To evaluate the efficacy of intra-articularly injected autologous PL in equine athletes with naturally occurring osteoarthritis. Fifteen warmblood geldings aged 8-19 years with osteoarthritis of the distal interphalangeal joint were included in this study. They were randomly divided into two groups; 10 horses received intra-articular injections of PL and 5 of normal saline (controls). Before treatment, platelet-derived growth factor (PDGF) levels in basal plasma and prepared PL were estimated. Each joint was injected twice within a three-week period. Lameness was evaluated using the American Association of Equine Practitioners grading system, before treatment and 10 days after each intra-articular injection. Horses were examined fortnightly for one year. Radiographic examination was performed six months post-treatment. The generalized estimating equation test was used for statistical analysis. Acceptable levels of PDGF were detected in PLs (mean ± SD: 258.0 ± 52.3 pg/ml). The majority of horses (9/10) responded positively to PL treatment presenting lower lameness grades (p < 0.0005) compared to controls 10 days after the second injection, and returned to normal athletic activity. Radiographs revealed no changes in osteoarthritis lesions six months after treatment. One year post-injections, however, all horses relapsed to their initial degree of lameness. Intra-articularly injected autologous PL is an efficient method for temporarily managing osteoarthritis of the distal interphalangeal joint in athletic horses.

  18. Gait Changes Vary Among Horses with Naturally Occurring Osteoarthritis Following Intra-articular Administration of Autologous Platelet Rich Plasma

    Directory of Open Access Journals (Sweden)

    Mustajab Hussain Mirza

    2016-04-01

    Full Text Available Mechanisms to reduce lameness associated with osteoarthritis (OA are vital to equine health and performance. This study was designed to quantify response to autologous, intra-articular platelet-rich plasma (PRP in horses with OA. Kinetic gait analysis was performed on 12 horses with unilateral forelimb lameness and OA in the same limb before and after intra-articular anesthesia (IAA. Radiographs and kinetic data were obtained before, 6 and 16 weeks after PRP administration to same joint 4 weeks after IAA. Statistical evaluations included filtration effect on platelet concentration, relationship between kinetic variable changes after IAA versus PRP in the affected limb, and associations between response to PRP and response to IAA, platelet concentration and radiographic OA. A positive response to IAA or PRP was defined as ≥5% improvement in peak vertical force, vertical impulse or breaking impulse of the affected limb. Out of 10 horses that responded to IAA, 4 responded to PRP at both time points and 2 responded at one. Of 2 horses that did not respond to IAA, one responded to PRP at both time points. Filtration increased platelet concentration significantly. The relationship between kinetic variable alterations of the affected limb after IAA and PRP was not significant, and response to PRP was not associated with response to IAA, platelet concentration or radiographic OA. Changes in kinetic variables following IAA in joints with naturally occurring OA provide a custom standard to assess intra-articular therapy. Kinetic gait changes after intra-articular PRP are variable in horses with moderate to severe forelimb OA.

  19. Intra-Articular Entrapment of the Medial Epicondyle following a Traumatic Fracture Dislocation of the Elbow in an Adult

    Science.gov (United States)

    Hassan, Youssef G.; Joukhadar, Nabih I.

    2018-01-01

    Medial epicondyle entrapment after an acute fracture dislocation of the elbow is a common finding in the pediatric population, but a rare finding in adults. We present a case of an adult patient diagnosed with a traumatic fracture dislocation of the elbow joint with intra-articular entrapment of the medial epicondyle. After initial evaluation, closed reduction was done. Stability testing after reduction showed an unstable joint; thus, open reduction and internal fixation was decided. PMID:29666736

  20. Intraarticular application of superparamagnetic nanoparticles and their uptake by synovial membrane-an experimental study in sheep

    International Nuclear Information System (INIS)

    Schulze, Katja; Koch, Annette; Schoepf, Bernhard; Petri, Alke; Steitz, Benedikt; Chastellain, Mathieu; Hofmann, Margarethe; Hofmann, Heinrich; Rechenberg, Brigitte von

    2005-01-01

    A superparamagnetic iron oxide nanoparticle, coated with polyvinyl alcohol (PVA-SPION) and its fluorescently functionalized analogue (amino-PVA-Cy3.5-SPION) were compared in vivo as proof of principle for future use in magnetic drug targeting in inflammatory joint diseases. They were injected either intraarticularly or periarticularly and their uptake by cells of the synovial membrane was evaluated. Uptake was completed in 48 h and was enforced by an extracorporally applied magnet

  1. Efeitos hemodinâmicos da anestesia em plano profundo com infusão intravenosa contínua de propofol ou propofol associado à lidocaína em cães

    Directory of Open Access Journals (Sweden)

    Rodrigo Mannarino

    2014-02-01

    Full Text Available Os efeitos hemodinâmicos da anestesia total intravenosa com propofol ou propofol associado à lidocaína foram estudados em 12 cães. No grupo P (n=6, os animais receberam bolus de 6mg kg-1 de propofol e infusão contínua de 1,25mg kg-1 min-1. No grupo PL (n=6, os animais receberam bolus de 6mg kg-1 de propofol e 1,5mg kg-1 de lidocaína, seguido de infusão de 1,0mg kg-1 min-1 e 0,25mg kg-1 min-1, dos mesmos fármacos, respectivamente. Os animais foram instrumentados para mensuração das variáveis hemodinâmicas e do índice bispectral (BIS, aos 75, 90, 105 e 120 minutos de anestesia. Foram observados valores menores de índice cardíaco, índice sistólico, pressões arteriais sistólica, diastólica e média no grupo P do que no grupo PL (P<0,05. Não foram observadas diferenças entre os grupos na frequência cardíaca, índice de resistência vascular sistêmica e BIS. As concentrações plasmáticas de propofol foram menores no grupo PL do que no grupo P (medianas de 5,7 a 6,1µg mL-1 no grupo P versus 3,1 a 3,7µg mL-1 no grupo PL. As concentrações plasmáticas de lidocaína (medianas de 2,27 a 2,51µg mL-1 mensuradas encontram-se na faixa que resulta em analgesia e abaixo de valores que resultam em toxicidade em cães. Os valores de BIS obtidos nos dois grupos foram compatíveis com plano profundo de anestesia (médias de 43 a 46 e 45 a 49 nos grupos P e PL, respectivamente. A manutenção da anestesia em plano profundo com lidocaína-propofol causa menor depressão cardiovascular do que a anestesia com dose equipotente de propofol isoladamente.

  2. Analgesic Effect of Intra-Articular Injection of Temperature-Responsive Hydrogel Containing Bupivacaine on Osteoarthritic Pain in Rats

    Science.gov (United States)

    Kim, Taemin; Seol, Dong Rim; Hahm, Suk-Chan; Ko, Cheolwoong; Kim, Eun-Hye; Chun, Keyoungjin; Kim, Junesun; Lim, Tae-Hong

    2015-01-01

    The present study examined the analgesic effects of slow-releasing bupivacaine from hydrogel on chronic arthritic pain in rats. Osteoarthritis (OA) was induced by monosodium iodoacetate (MIA) injection into the right knee joint. Hydrogel (HG: 20, 30, and 50 μL) and temperature-sensitive hydrogel containing bupivacaine (T-gel: 20, 30, and 50 μL) were injected intra-articularly 14 days after MIA injection. Behavioral tests were conducted. The rats showed a significant decrease in weight load and paw withdrawal threshold (PWT). Intra-articular 0.5% bupivacaine (10 and 20 μL) significantly reversed MIA-induced decreased PWT, with no effect on weight load. In normal rats, hydrogel did not produce significant changes in PWT but at 30 and 50 μL slightly decreased weight bearing; T-gel did not cause any changes in both the weight load and PWT. In OA rats, T-gel at 20 μL had a significant analgesic effect for 2 days, even though T-gel at 50 μL further reduced the weight load, demonstrating that intra-articular T-gel (20 μL) has long-lasting analgesic effects in OA rats. Thus, T-gel designed to deliver analgesics into the joint cavity could be an effective therapeutic tool in the clinical setting. PMID:26881207

  3. Open reduction and internal fixation of intra-articular fractures of the mandibular condyle: our first experiences.

    Science.gov (United States)

    Vesnaver, Ales

    2008-10-01

    Treatment of intra-articular fractures of the mandibular condyle head is conservative at most institutions dealing with facial fractures. Recently, reports had been published about benefits of surgical treatment in these fractures. From July 2004 until the end of June 2006, 13 patients with 16 displaced intra-articular fractures of the mandibular condyle were treated with open reduction and internal fixation at the Department of Oral and Maxillofacial Surgery in Ljubljana, Slovenia, using the preauricular approach and the lag screw technique. Twelve of the 13 patients could open their mouths for 40 mm or more, and 10 had a deflection of the chin of less than 2 mm upon maximal opening. None of the patients experienced pain upon rest, palpation, or chewing. Occlusion was not noted as altered in any of the cases, neither subjectively, nor on examination. There were no cases of postoperative weakness of the temporal branch of the facial nerve. Surgical treatment of intra-articular condyle fractures using the preauricular approach achieves a good exposure and enables proper reduction. Stable fixation of fractured bony fragments can be achieved using the lag screw technique. Another benefit of open exposure is revision and repair of TMJ soft tissues. With the appropriate surgical technique, the surgical procedure is safe and leads to good results.

  4. Effectiveness of intra-articular injections of sodium hyaluronate-chondroitin sulfate in knee osteoarthritis: a multicenter prospective study.

    Science.gov (United States)

    Rivera, Fabrizio; Bertignone, Luca; Grandi, Giancarlo; Camisassa, Roberto; Comaschi, Guido; Trentini, Diego; Zanone, Marco; Teppex, Giuseppe; Vasario, Gabriele; Fortina, Giorgio

    2016-03-01

    Intra-articular injection of hyaluronic acid is a well-established therapy for the treatment of knee osteoarthritis. The aim of the study was to assess the effectiveness and safety of the use of Arthrum HCS(®) (40 mg hyaluronic acid and 40 mg chondroitin sulfate in 2 mL). This was an open, multicenter, prospective study. Men or women over 40 years of age with documented knee osteoarthritis and WOMAC subscore A (severity of pain) ≥25 were enrolled. They received three weekly intra-articular injections of sodium hyaluronate 2 % and chondroitin sulfate 2 % in combination. WOMAC subscore A was assessed at 1, 3 and 6 months after the last injection. One hundred and twelve patients were included (women, 66 %). The mean (SD) WOMAC subscore A decreased from 52.1 (15.2) at inclusion to 20.5 (19.7) at month 6 (P chondroitin sulfate in reducing pain (77 %), improving mobility (78 %) and reducing the consumption of analgesics (74 %). Only one adverse effect was reported by one patient (knee tumefaction). These results suggest that intra-articular injections of Arthrum HCS(®) (sodium hyaluronate plus chondroitin sulfate) in patients with knee osteoarthritis are efficient and safe. These results should be confirmed in a randomized controlled study. IV.

  5. The use of an intraarticular catheter on fast-track primary knee arthroplasty, is it a step forward?

    Science.gov (United States)

    Cáceres-Sánchez, L; García-Benítez, J B; Coronado-Hijón, V; Montero-Pariente, M

    This study compares the efficacy in post-operative pain control of the intraarticular catheter compared to the epidural catheter after primary total knee arthroplasty. Randomised clinical trial consisting of two groups of patients. A control group with intradural anaesthesia and an intraoperative epidural catheter (ropivacaine) and an intervention group using the same anaesthetic technique and an intraarticular catheter with an elastomeric pump (ropivacaine+dexketoprofen). Data such as demographic, anaesthetic and surgical variables, pain intensity according to Verbal Rating Scale, opioid use and complications, joint balance, onset of walking and hospital stay were recorded. A lower incidence and severity on Verbal Rating Scale and a better control of postoperative pain (p.001). Finally, the hospital stay decreased significantly, with 33.3% of intervention group patients discharged within the first 48h compared to none of the control group. The use of the intraarticular catheter as postoperative analgesia is a useful and safe alternative. It reduces the possibility of side effects. It helps in early improvement of joint balance, onset of walking and control of pain. All of which increase patient satisfaction and result in a shorter period of hospitalisation. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Pharmacokinetics of betamethasone in plasma, urine, and synovial fluid following intra-articular administration to exercised thoroughbred horses.

    Science.gov (United States)

    Knych, Heather K; Stanley, Scott D; Harrison, Linda M; Mckemie, Daniel S

    2017-09-01

    The use of corticosteroids, such as betamethasone, in performance horses is tightly regulated. The objective of the current study was to describe the plasma pharmacokinetics of betamethasone as well as time-related urine and synovial fluid concentrations following intra-articular administration to horses. Twelve racing-fit adult Thoroughbred horses received a single intra-articular administration (9 mg) of a betamethasone sodium phosphate and betamethasone acetate injectable suspension into the right antebrachiocarpal joint. Blood, urine, and synovial fluid samples were collected prior to and at various times up to 21 days post drug administration. All samples were analyzed using tandem liquid chromatography-mass spectrometry. Plasma data were analyzed using compartmental pharmacokinetic modeling. Maximum measured plasma betamethasone concentrations were 3.97 ± 0.23 ng/mL at 1.45 ± 0.20 h. The plasma elimination half-life was 7.48 ± 0.39 h. Betamethasone concentrations were below the limit of detection in all horses by 96 h and 7 days in plasma and urine, respectively. Betamethasone fell below the limit of detection in the right antebrachiocarpal joint between 14 and 21 days. Results of this study provide information that can be used to regulate the use of intra-articular betamethasone in the horse. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

  7. [Sinus tarsi approach combined with medial distraction technique for treatment of intra-articular calcaneus fractures].

    Science.gov (United States)

    Zhou, Haichao; Ren, Haoyang; Li, Bing; Yu, Tao; Yang, Yunfeng

    2016-07-08

    ?To discuss the effectiveness of limited open reduction via sinus tarsi approach using medial distraction technique in the treatment of intra-articular calcaneus fractures by comparing with open reduction and internal fixation via extensile L-shaped incision. ?A retrospective analysis was made on the clinical data of 21 patients with intra-articular calcaneus fractures treated by sinus tarsi approach combined with medial distraction technique between April 2013 and November 2014 (minimally invasive group), and 32 patients treated by extensile L-shaped incision approach between June 2012 and September 2014 (extensile incision group). No significant difference was found in gender, age, injury pattern, fracture classification, time from injury to operation, preoperative Böhler angle, Gissane angle, calcaneal varus angle, the ankle and hind-foot score of American Orthopaedic Foot and Ankle Society (AOFAS), and visual analogue scale (VAS) score between 2 groups (P>0.05), which was comparable. The operation time, wound complications, and bone healing time were recorded. The postoperative function was also evaluated by AOFAS score and VAS score. The pre-and post-operative Böhler angle, Gissane angle, and calcaneal varus angle were measured on the X-ray films, and the corrective angle was calculated. ?Sixteen patients were followed up 6-18 months (mean, 11.5 months) in the minimally invasive group, and 23 patients for 6-24 months (mean, 13.5 months) in the extensile incision group. Difference was not significant in operation time between 2 groups (t=0.929, P=0.796). No complication occurred in the minimally invasive group; partial skin flap necrosis occurred in 3 cases of the extensile incision group, was cured after dressing change. There was no loosening of implants or reduction loss in 2 groups at last follow-up. Subtalar joint stiffness occurred in 1 case of the minimally invasive group and 4 cases of the extensile incision group, and 1 patient had discomfort for the

  8. Anestesia para cesariana em gestante com hipoplasia de aorta distal: relato de caso Anestesia para cesárea en embarazada con hipoplasia de aorta distal: relato de caso Anesthesia for cesarean section on a pregnant woman with hypoplasia of the distal aorta: case report

    Directory of Open Access Journals (Sweden)

    Leonardo de Andrade Reis

    2008-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Anomalias vasculares maternas, potencialmente graves para o feto, podem colocar em risco a perfusão uterina, suscitando cuidados ainda maiores por parte da equipe anestésica. O objetivo deste relato foi mostrar a conduta anestésica para operação cesariana em uma gestante com hipoplasia de aorta distal, logo abaixo da emergência das artérias renais, com estenose da artéria renal e ausência de artérias ilíacas. RELATO DO CASO: Paciente de 30 anos, 54 kg, na segunda gestação com uma cesariana anterior sem intercorrências. Durante a realização de ecografia gestacional na 12ª semana observou-se interrupção da aorta logo abaixo da saída das artérias renais. A paciente foi encaminhada para a realização de cineangiocoronariografia que mostrou hipoplasia da aorta distal abaixo das artérias renais, com ausência das artérias ilíacas. Durante a investigação clínica a paciente mostrou-se assintomática, com exceção de hipertensão arterial e claudicação aos grandes esforços. A paciente foi submetida à anestesia peridural contínua, com titulação da dose anestésica necessária à realização da cesariana. Inicialmente foram injetados 50 mg de bupivacaína a 0,5% sem vasoconstritor e 10 µg de sufentanil. Quinze minutos após, a anestesia foi complementada com mais 25 mg de bupivacaína a 0,5%, o que foi suficiente para atingir adequado nível de bloqueio. A cesariana transcorreu sem intercorrências e a criança nasceu em boas condições clínicas. CONCLUSÕES: O uso de anestesia peridural contínua com doses fracionadas demonstrou ser uma técnica anestésica segura para a realização desse procedimento por reduzir os riscos de hipotensão arterial materna inerente ao bloqueio espinal e também por minimizar a transferência placentária de fármacos, que ocorrem quando do emprego da anestesia geral. A titulação de fármacos através do cateter peridural possibilitou atingir nível anest

  9. Novel bioadhesive polymers as intra-articular agents: Chondroitin sulfate-cysteine conjugates.

    Science.gov (United States)

    Suchaoin, Wongsakorn; Bonengel, Sonja; Griessinger, Julia Anita; Pereira de Sousa, Irene; Hussain, Shah; Huck, Christian W; Bernkop-Schnürch, Andreas

    2016-04-01

    The aim of this study was to generate and characterize a chondroitin sulfate-cysteine conjugate (CS-cys) as a novel bioadhesive agent for intra-articular use. Mucoadhesive properties of synthesized CS-cys were investigated by rheological measurement of polymer-mucus mixture and rotating cylinder method, while bioadhesive features of CS-cys on porcine articular cartilage were evaluated via tensile studies. Thiolation was achieved by attachment of l-cysteine to CS via amide bond formation mediated by carbodiimide as a coupling reagent. The conjugate exhibited 421.17±35.14 μmol free thiol groups per gram polymer. The reduced CS-cys displayed 675.09±39.67 μmol free thiol groups per gram polymer after disulfide bonds reduction using tris(2-carboxyethyl)phosphine hydrochloride. The increase in dynamic viscosity of thiolated CS due to oxidative disulfide bond formation was demonstrated using capillary viscometer. The combination of CS-cys and mucus led to 4.57-fold increase in dynamic viscosity in comparison with mucus control. Furthermore, adhesion time to porcine mucosa of CS-cys-based test disk was enhanced by 2.48-fold compared to unmodified CS as measured by rotating cylinder method suggesting the interaction between thiomers and mucus gel layer via disulfide bonds formation. Tensile studies of thiolated CS on porcine articular cartilage showed 5.37- and 1.76-fold increase in the total work of adhesion and the maximum detachment force, respectively, in comparison with unmodified CS indicating bioadhesive features of CS-cys. Cytotoxicity of CS-cys was assessed in Caco-2 cells and rat primary articular chondrocytes using MTT and LDH release assay, thereby showing the safety of CS-cys at a concentration of 0.25% (w/v) in Caco-2 cells. Furthermore, 0.1% of CS-cys was found non-toxic to rat primary articular chondrocytes. According to these results, CS-cys provides improved bioadhesive properties that might be useful as an intra-articular agent for treatment of

  10. Interobserver and intraobserver reliability of two classification systems for intra-articular calcaneal fractures.

    Science.gov (United States)

    Lauder, Anthony J; Inda, David J; Bott, Aaron M; Clare, Michael P; Fitzgibbons, Timothy C; Mormino, Matthew A

    2006-04-01

    For a fracture classification to be useful it must provide prognostic significance, interobserver reliability, and intraobserver reproducibility. Most studies have found reliability and reproducibility to be poor for fracture classification schemes. The purpose of this study was to evaluate the interobserver and intraobserver reliability of the Sanders and Crosby-Fitzgibbons classification systems, two commonly used methods for classifying intra-articular calcaneal fractures. Twenty-five CT scans of intra-articular calcaneal fractures occurring at one trauma center were reviewed. The CT images were presented to eight observers (two orthopaedic surgery chief residents, two foot and ankle fellows, two fellowship-trained orthopaedic trauma surgeons, and two fellowship-trained foot and ankle surgeons) on two separate occasions 8 weeks apart. On each viewing, observers were asked to classify the fractures according to both the Sanders and Crosby-Fitzgibbons systems. Interobserver reliability and intraobserver reproducibility were assessed with computer-generated kappa statistics (SAS software; SAS Institute Inc., Cary, North Carolina). Total unanimity (eight of eight observers assigned the same fracture classification) was achieved only 24% (six of 25) of the time with the Sanders system and 36% (nine of 25) of the time with the Crosby-Fitzgibbons scheme. Interobserver reliability for the Sanders classification method reached a moderate (kappa = 0.48, 0.50) level of agreement, when the subclasses were included. The agreement level increased but remained in the moderate (kappa = 0.55, 0.55) range when the subclasses were excluded. Interobserver agreement reached a substantial (kappa = 0.63, 0.63) level with the Crosby-Fitzgibbons system. Intraobserver reproducibility was better for both schemes. The Sanders system with subclasses included reached moderate (kappa = 0.57) agreement, while ignoring the subclasses brought agreement into the substantial (kappa = 0.77) range

  11. Sports activity after surgical treatment of intra-articular tibial plateau fractures in skiers.

    Science.gov (United States)

    Loibl, Markus; Bäumlein, Martin; Massen, Felix; Gueorguiev, Boyko; Glaab, Richard; Perren, Thomas; Rillmann, Paavo; Ryf, Christian; Naal, Florian D

    2013-06-01

    Tibial plateau fractures occur frequently while participating in winter sports, but there is no information on whether skiers can resume sports and recreational activities after internal fixation of these fractures. Skiers can resume low-impact sports activity after internal fixation of tibial plateau fractures. Case series; Level of evidence, 4. A total of 103 patients were surveyed by postal questionnaires to determine their sports activities at a mean of 7.8 ± 1.8 years after internal fixation of intra-articular tibial plateau fractures. The survey also included the Lysholm score, the Tegner activity scale, and a visual analog scale (VAS) for pain. At the time of the survey, 88% of the patients were engaged in sports activities (rate of return to sports, 88%), and 53% continued to participate in downhill skiing. The median number of different activities declined from 5 (range, 1-17) preoperatively to 4 (range, 0-11) postoperatively (P Sports frequency and duration per week did not change: 3 (range, 1-7) preoperatively versus 3 (range, 0-7) postoperatively (P = .275) and 4 hours (range, 1-16 hours) preoperatively versus 3.5 hours (range, 0-15 hours) postoperatively (P = .217), respectively. Median values of all outcome scores declined: Lysholm score, 100 (range, 85-100) preoperatively versus 94.5 (range, 37-100) postoperatively (P sports at the time of follow-up compared with the ability before the accident was rated as "similar" by 57 patients (62.0%) and as "worse" by 35 patients (38.0%). The more severe fracture types, B3 and C3 according to the AO classification system, were associated with poorer outcomes related to return to sports and functional scores. A large percentage of skiers with surgically treated intra-articular tibial plateau fractures cannot continue to participate in downhill skiing; however, the majority could resume an active lifestyle for several years after the trauma. Fracture type seems to be an important factor influencing physical

  12. Anestesia venosa total (AVT em lactente com doença de Werdnig-Hoffmann: relato de caso Anestesia venosa total (AVT en lactante con enfermedad de Werdnig-Hoffmann: relato de caso Total intravenous anesthesia (TIVA in an infant with Werdnig-Hoffmann disease: case report

    Directory of Open Access Journals (Sweden)

    Luis Otavio Esteves

    2010-10-01

    Full Text Available Foi com grande interesse que li o artigo "Anestesia Venosa Total (AVT em Lactente com Doença de Werdnig-Hoffmann. Relato de Caso", de Resende e col. ¹, publicado nesta revista. Gostaria, em primeiro lugar, de parabenizar os autores pela iniciativa. Entretanto, dois pontos me chamaram a atenção. O primeiro refere-se à definição de lactente, a qual compreende o período de 1 a 12 meses de idade. A partir de 12 meses, define-se como pré-escolar ou apenas criança. No artigo, o autor coloca a idade do paciente como 1 ano, mas não especifica meses ou dias. Provavelmente, esse paciente tem mais de 12 meses, sendo, dessa forma, a definição de lactente inadequada. O segundo e mais importante ponto diz respeito à técnica usada e ao título do artigo. No título, utilizou-se a expressão "anestesia venosa total", mas no relato foi dito que, além de propofol e remifentanil, a anestesia foi mantida com oxigênio e N2O. Se foi usado um gás com propriedades anestésicas (N2O, não seria correto classificar essa técnica como venosa total. Além disso, ele cita o artigo de Crawford e col. ², que definiu doses de remifentanil para intubação em crianças. Esse estudo foi realizado utilizando-se oxigenação na concentração de 100%, pois os autores provavelmente entendem que a adição de gases com propriedades anestésicas interferiria nos resultados obtidosFue con un gran interés que leí el artículo "Anestesia Venosa Total (AVT en Lactante con Enfermedad de Werdnig-Hoffmann. Relato de Caso", de Resende y col. ¹, publicado en esta revista. Y de hecho quiero, en primer lugar, felicitar a los autores por la iniciativa. Sin embargo, dos puntos me llamaron la atención. El primero, se refiere a la definición de lactante, la cual abarca el período de 1 a 12 meses de edad. A partir de los 12 meses, se define como preescolar o apenas como niño. En el artículo, el autor coloca la edad del paciente como de 1 año, pero no especifica meses o d

  13. Alterações eletroneurofisiológicas em anestesia com sevoflurano: estudo comparativo entre pacientes saudáveis e pacientes com paralisia cerebral Alteraciones eletroneurofisiológicas en anestesia con sevoflurano: estudio comparativo entre pacientes saludables y pacientes con parálisis cerebral Electroneourophysiological changes in anesthesia with sevoflurane: comparative study between healthy and cerebral palsy patients

    Directory of Open Access Journals (Sweden)

    Sérgio Silva de Mello

    2003-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Estudos avaliando a farmacodinâmica de drogas anestésicas em Paralisia Cerebral (PC são escassos. O objetivo deste estudo foi comparar a resposta eletroneurofisiológica de pacientes normais e com PC à anestesia com sevoflurano, utilizando o EEG bispectral (BIS e potencial evocado somatossensitivo de curta latência (PESS como técnica de monitorização do grau de profundidade anestésica. MÉTODO: Foram selecionados 24 pacientes de 3 a 18 anos, candidatos a cirurgias na Rede Sarah de Hospitais do Aparelho Locomotor, divididos em 2 grupos: 1. PC - 12 crianças com PC tipo espástica; 2. Controle (C - 12 crianças sem doença do SNC. A anestesia foi realizada com sevoflurano associado a N2O a 60% em ventilação assistida. As variáveis BIS e ondas N9, N13, N19 e P/N 22 do PESS - latência e amplitude - foram avaliadas nas frações expiradas de sevoflurano (FEsev de 1,2 e 2,5% (0,5 e 1 CAM. Foram monitorizadas a temperatura e a P ET CO2. Para análise foram utilizadas média e desvio-padrão para o BIS, e média da variação percentual dos valores de latência e amplitude das ondas do PESS, nas duas concentrações do anestésico. RESULTADOS: Não houve diferença de sexo, idade, peso e temperatura entre os grupos. Sob efeito da anestesia, os valores de BIS foram mais reduzidos no grupo PC, sendo a diferença entre os grupos estatisticamente significante com a FEsev 2,5% (30,3 x 37,5; p JUSTIFICATIVA Y OBJETIVOS: Estudios evaluando la farmacodinámica de drogas anestésicas en Parálisis Cerebral (PC son escasos. El objetivo de este estudio fue comparar la respuesta eletroneurofisiológica de pacientes normales y con PC a la anestesia con sevoflurano, utilizando el EEG bispectral (BIS y potencial evocado somatosensitivo de corta latencia (PESS como técnica de monitorización del grado de profundidad anestésica. MÉTODO: Fueron seleccionados 24 pacientes de 3 a 18 años, candidatos a cirugías en la Red Sarah de

  14. Anestesia em paciente portadora de síndrome de Mckusick-Kaufman: relato de caso Anestesia en paciente portadora de síndrome de Mckusick-Kaufman: relato de caso Anesthesia in Mckusick-Kaufman syndrome patient: case report

    Directory of Open Access Journals (Sweden)

    Adriano Bechara de Souza Hobaika

    2004-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A síndrome de Mckusick-Kaufman é uma doença rara, caracterizada tipicamente por hidrometrocolpos, polidactilia e defeitos cardíacos congênitos. Pacientes portadores desta doença podem ser submetidos a diversos procedimentos cirúrgicos durante a sua vida e o anestesiologista deve estar preparado para possíveis alterações. O objetivo deste artigo é relatar a conduta anestésica adotada em uma paciente portadora desta síndrome. RELATO DO CASO: Paciente do sexo feminino de 11 anos, 37 kg, portadora da síndrome de Mckusick-Kaufman, insuficiência renal crônica, encefalopatia hipertensiva e asma grave submetida à retirada de cateter peritoneal infectado e confecção de fístula arteriovenosa. História pregressa de intubação prolongada. A anestesia foi induzida com alfentanil (1 mg, propofol (50 mg e atracúrio (25 mg e mantida com sevoflurano (2% a 4% e doses fracionadas de alfentanil. A traquéia foi intubada sem complicações e a extubação foi realizada na sala de cirurgia após o retorno satisfatório da função neuromuscular. CONCLUSÕES: Apesar de a síndrome de Mckusick-Kaufman tratar-se de uma associação variável de defeitos congênitos, alguns cuidados anestésicos comuns podem ser definidos. Este caso apresentou fatores complicadores da anestesia e a indução com propofol e alfentanil e a manutenção com sevoflurano proporcionaram à paciente uma anestesia com mínimas repercussões ventilatórias e hemodinâmicas.JUSTIFICATIVA Y OBJETIVOS: La síndrome de Mckusick-kaufman es una dolencia rara, caracterizada típicamente por hidrometrocolpos, polidactilia y defectos cardiacos congénitos. Pacientes portadores de esta enfermedad pueden ser sometidos a varios procedimientos cirúrgicos durante su vida y el anestesiologista debe estar preparado para posibles alteraciones. El objetivo de este artículo es relatar la conducta anestésica adoptada en una paciente portadora de este s

  15. Anestesia em criança com síndrome de Pallister-Killian: relato de caso Anestesia en niño con síndrome de Pallister-Killian: relato de caso Anesthesia in child with Pallister-Killian syndrome: case report

    Directory of Open Access Journals (Sweden)

    José Roquennedy Souza Cruz

    2004-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A síndrome de Pallister-Killian (SPK é uma doença genética rara causada por uma anomalia, em mosaico, no cromossomo 12. Há pouca informação sobre esta síndrome na literatura anestésica. O objetivo deste relato foi divulgar e discutir as características que podem ser de interesse para a anestesia. RELATO DO CASO: Paciente do sexo masculino, 5 anos de idade, foi submetido a anestesia geral para a realização de ressonância magnética do crânio. Apresentava as características típicas da SPK: dismorfismo facial, alopecia temporal, micrognatismo, macroglossia, retardo mental, convulsões e alterações pigmentares cutâneas. A anestesia foi induzida e mantida com sevoflurano sob máscara facial e cânula orofaríngea, com ventilação assistida manual durante a indução. Não houve intercorrências e o exame foi feito em regime ambulatorial. CONCLUSÕES: A importância da avaliação pré-anestésica é enfatizada, devido às malformações, inclusive cardíacas, associadas a esta síndrome. É recomendada a preparação para possível dificuldade de intubação traqueal ou de manutenção das vias aéreas.JUSTIFICATIVA Y OBJETIVOS: La síndrome de Pallister-Killian (SPK es una rara enfermedad genética causada por una anomalía, en mosaico, en el cromosoma 12. Hay poca información sobre esta síndrome en la literatura anestésica. El objetivo de este relato fue divulgar y discutir las características que pueden ser de interés para la anestesia. RELATO DEL CASO: Paciente del sexo masculino, 5 años de edad, fue sometido a anestesia general para la realización de resonancia magnética del cráneo. Presentaba las características típicas de la SPK: dismorfismo facial, alopecia temporal, micrognatismo, macroglosia, retardo mental, convulsiones y alteraciones pigmentares cutáneas. La anestesia fue inducida y mantenida con sevoflurano sobre máscara facial y cánula orofaríngea, con ventilación manual

  16. Anestesia regional e trombocitopenia não pré-eclâmptica; hora de repensar o nível seguro de plaquetas Anestesia regional y trombocitopenia no preclámptica; es hora de pensar de nuevo sobre el nivel seguro de plaquetas Regional anesthesia and non-preeclamptic thrombocytopenia: time to re-think the safe platelet count

    Directory of Open Access Journals (Sweden)

    Motoshi Tanaka

    2009-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Apesar de a anestesia regional ser amplamente utilizada no controle da dor em obstetrícia, seu uso pode não ser apropriado nas pacientes com trombocitopenia por causa do risco de hematoma no neuroeixo. Não existem fortes evidências sugerindo número mínimo de plaquetas necessário para garantir a segurança na realização da anestesia regional. O objetivo deste estudo foi rever a segurança da anestesia regional em pacientes com trombocitopenia não pré-eclâmptica na instituição durante período de cinco anos. MÉTODO: Foi realizada revisão retrospectiva dos prontuários médicos de todas as pacientes obstétricas não pré-eclâmpticas cujo parto foi realizado na instituição entre abril de 2001 e março de 2006 e que apresentaram contagem de plaquetas JUSTIFICATIVA Y OBJETIVOS: A pesar de que la anestesia regional esté siendo muy utilizada en el control del dolor en obstetricia, su uso puede no ser muy apropiado en las pacientes con trombocitopenia, debido al riesgo de hematoma en el neuro eje. No existen fuertes evidencias que sugieran un número mínimo de plaquetas necesario para garantizar la seguridad en la realización de la anestesia regional. El objetivo de este estudio fue analizar la seguridad de la anestesia regional en pacientes con trombocitopenia no preeclámptica en la institución durante un período de cinco años. MÉTODO: Fue realizada revisión retrospectiva de las historias clínicas médicas de todas las pacientes obstétricas no preeclámpticas cuyo parto fue realizado en la institución entre abril de 2001 y marzo de 2006 y que presentaron BACKGROUND AND OBJECTIVES: Although regional anesthesia is widely used for pain control in obstetrics, it may not be appropriate for patients with thrombocytopenia due to the risk of neuraxial hematoma. There is no strong evidence to suggest the minimum platelet count that is necessary to ensure the safe practice of regional anesthesia. The

  17. Anestesia em gestante com hipertensão intracraniana por meningite tuberculosa: relato de caso Anestesia en gestante con hipertensión intracraneal por meningitis tísica: relato de caso Anesthesia in pregnant patient with intracranial hypertension due to tuberculous meningitis: case report

    Directory of Open Access Journals (Sweden)

    Vanessa Breitenbach

    2005-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Está bem estabelecido que a técnica anestésica de escolha para cesariana eletiva é a anestesia regional. Porém, em gestantes com hipertensão intracraniana e infecção do sistema nervoso central esta técnica deve ser evitada. O objetivo deste artigo é relatar o manejo anestésico de uma gestante, com hipertensão intracraniana secundária à meningite tuberculosa, que foi submetida à cesariana eletiva. RELATO DO CASO: Paciente branca, 32 anos, 60 kg, 1,62 m de estatura, na 36ªsemana de idade gestacional, agendada para interrupção cirúrgica da gestação por apresentar-se tetraparética, com hidrocefalia decorrente de meningite tuberculosa. Escolheu-se a anestesia geral para a cesariana com indução em seqüência rápida e manobra de Sellick para a intubação traqueal. As drogas utilizadas foram tiopental (250 mg, rocurônio (50 mg, fentanil (100 µg e lidocaína (60 mg por via venosa. A indução anestésica foi suave e mantida com isoflurano até o início do fechamento da pele da paciente, com mínimas alterações de seus sinais vitais e do recém-nascido, que recebeu índice de Apgar 8 e 9, no 1º e 5º minutos, respectivamente. A paciente despertou precocemente, sem deficits neurológicos adicionais. CONCLUSÕES: A anestesia geral ainda é a técnica anestésica preferida para cesariana em gestantes com hipertensão intracraniana, utilizando-se drogas de meia-vida curta e que tenham mínima interferência na pressão intracraniana e no recém-nascido.JUSTIFICATIVA Y OBJETIVOS: Está bien establecido que la técnica anestésica de elección para cesárea electiva es la anestesia regional. Sin embargo, en gestantes con hipertensión intracraneal e infección del sistema nervioso central esta técnica debe ser evitada. El objetivo de este artículo es relatar el manejo anestésico de una gestante, con hipertensión intracraneal secundaria a la meningitis tísica, que fue sometida a la ces

  18. The significance of the intraarticular anesthesia of the tarsometatarsal joint for the diagnosis of lameness in the horse, with special reference to bone spavin

    International Nuclear Information System (INIS)

    Buchner, H.H.F.

    1991-01-01

    Intraarticular anesthesia of the tarsometatarsal joint as a part of the diagnosis of lameness in the horse was evaluated regarding the anatomical features and clinical importance. At first, in 37 hock joints of necropsy material the communications between tarsometatarsal and distal intertarsal joint were studied using simultaneously a corrosion casting technique and a radiographic contrast technique. Radiographically in 25.8 % of the cases a communication could be demonstrated. Using corrosion casting technique, in 9.1 % a wide connection between the joints was evident, whilst in 37.3 % only a low grade connection existed. In 40 hock joints of living horses, communication between the joints were evaluated arthrographically, using Conray 60 R as contrast medium. In 28 % of the tarsal joints communications between tarsometatarsal and distal intertarsal joint could be demonstrated. In 13 horses suffering from bone spavin the effect of the intraarticular tarsometatarsal anesthesia was evaluated: first in a subjective manner on judgement by the veterinarian, second in an objective manner using an optoelectronical locomotion analysis system (SELSPOT II). In 10 of these horses also the BERGE-anesthesia was evaluated. Using the locomotion analysis, a highly significant improvement of lameness was seen in 30 % of the horses following intraarticular tarsometatarsal anesthesia and in 28 % following BERGE-anesthesia. On subjective judgement after intraarticular tarsometatarsal anesthesia, 15.4% of the horses showed a moderate improvement, whilst 38.5% showed a middle graded improvement of the lameness. The necessity of a critical judgement of lameness after diagnostic anesthesias in cases of a minor degree hindlimb lameness has to be pointed out. There was no plain correlation between radiological findings and the results of intraarticular anesthesia. As a general tendency, horses with mild radiological changes do respond to intraarticular anesthesia better. Due to the lack of

  19. Evaluación costo-efectividad de lidocaína al 5 % y bupivacaína al 0,5 % en anestesia espinal

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    Eréndira González Orozco

    Full Text Available Se realizó un estudio económico prospectivo de costo-efectividad con datos primarios de efectividad obtenidos de un ensayo clínico aleatorizado, donde se comparan 2 anestésicos vía espinal: lidocaína al 5 % y bupivacaína al 0,5 %. La efectividad se evaluó como la probabilidad de aparición de síntomas neurológicos transitorios, reacción adversa propia de este grupo de medicamentos. Se formaron aleatoriamente 2 grupos de pacientes que requerían cirugías por debajo del ombligo con una duración no mayor de 120 min, con la aplicación de cada una de las opciones de anestesia estudiada a cada grupo, 109 pacientes en el grupo de lidocaína y 97 en el grupo de bupivacaína. Un especialista en Neurología evaluó a ciegas la condición neurológica posquirúrgica de cada paciente antes y 24 h después de la intervención. Se calcularon los costos de cada alternativa, que incluyeron los ocasionados por la toxicidad neurológica, y se determinaron las relaciones costo-efectividad y los costos incrementales. El grupo de bupivacaína resultó la alternativa con mejor relación costo-efectividad

  20. Arthroscopic approach and intraarticular anatomy of the stifle in South American camelids.

    Science.gov (United States)

    Pentecost, Rebecca L; Niehaus, Andrew J; Santschi, Elizabeth

    2012-05-01

    To describe a cranial arthroscopic approach to the stifle of South American camelids and to report our clinical experience with camelid stifle arthroscopy. Experimental study and retrospective case series. (1) Cadaveric alpaca hindlimbs (n = 18; 9 alpacas); (2) 1 alpaca and 1 llama Polymethylmethacrylate joint casts (n = 2) were made to define stifle joint dimensions. Cadaveric stifle joints (n = 16) were evaluated arthroscopically to determine arthroscopic portal locations, describe the intraarticular anatomy, and report potential complications. An alpaca and a llama with stifle joint disease had diagnostic arthroscopy. Successful entry into the stifle joint was achieved in 16 cadaver limbs. Observed structures were: the suprapatellar pouch, articular surface of the patella, femoral trochlear ridges and groove, cranial aspect of the femoral condyles (n = 16); distal aspect of the cranial and proximal aspect of the caudal cruciate ligaments (14); and cranial aspects of the medial and lateral menisci (11), and cranial meniscotibial and intermeniscal ligaments (8). Stifle arthroscopy allowed for joint evaluation and removal of osteochondral fragments in 1 alpaca and 1 llama with naturally occurring stifle disease. Complications of cadaver or live procedures included minor cartilage scoring (3 stifles) and subcutaneous periarticular fluid accumulation (8 stifles). Arthroscopy provides a safe approach for diagnosis and treatment of stifle lesions in South American camelids. Copyright 2012 by The American College of Veterinary Surgeons.

  1. Prospective Evaluation of Intra-Articular Dextrose Prolotherapy for Treatment of Osteoarthritis in Dogs.

    Science.gov (United States)

    Sherwood, J Matthew; Roush, James K; Armbrust, Laura J; Renberg, Walter C

    The objective of this study was to evaluate intra-articular dextrose prolotherapy for osteoarthritis of the elbow or stifle in dogs in a randomized, double-blind, placebo-controlled, prospective pilot study. Seventeen dogs were evaluated with 10 meeting inclusion criteria for this study. Evaluations included orthopedic exam, visual lameness scoring, Canine Brief Pain Inventory (CBPI), goniometry, kinetic gait analysis, and radiography. Initial lameness score, age, body weight, duration of lameness, and CBPI scores did not differ between groups. Change in CBPI pain severity score in the prolotherapy group from wk 6-12 was significantly less improved than in the placebo group, with no other significant differences in pain severity or pain interference scores between groups. Range of motion and radiographic scores did not differ between groups at any time. Mean kinetic forces improved in prolotherapy dogs but were not significantly different between treatment groups at any time. Although easily performed and well-tolerated, there were no statistically significant benefits of dextrose prolotherapy for treatment of osteoarthritis of the elbow and stifle in dogs. Post hoc power analysis of these sample means and standard deviations found that 29-106 animals per group would be necessary to demonstrate significant differences in kinetic forces, providing useful guidance for future studies.

  2. Single intra-articular injection of high molecular weight hyaluronic acid for hip osteoarthritis.

    Science.gov (United States)

    Rivera, Fabrizio

    2016-03-01

    Intra-articular (IA) injection of hyaluronic acid (HA) into the hip joint appears to be safe and well tolerated but only a small number of randomized clinical trials in humans has been published. The objective of this prospective study was to evaluate the efficacy and safety of a single IA injection of high-molecular-weight (2800 kDa) HA (Coxarthrum) for hip osteoarthritis. All patients received a single IA administration of 2.5 % sodium hyaluronate (75 mg/3 mL) of high molecular weight. Fluoroscopy requires an iodized contrast medium (iopamidol, 1 ml) which highlights the capsule before administering HA. Patients were evaluated before IA injection (T0), after 3 months, after 6 months and after 1 year from injection. Results were evaluated by the Brief Pain Inventory (BPI II), Harris Hip Score and a visual analog scale of pain (pain VAS). All treated patients were considered for statistical analysis. Two hundred seven patients were included at T0. The mean age was 67 years (range 46-81). Regarding BPI severity score, changes in pain between T0 and the three following visits were statistically highly significant (p injection of Coxarthrum is effective from the third month and that the results are stable or continue to improve up to 1 year. IV.

  3. Treatment of rheumatoid synovitis of the knee with intraarticular injection of dysprosium 165-ferric hydroxide macroaggregates

    International Nuclear Information System (INIS)

    Sledge, C.B.; Zuckerman, J.D.; Zalutsky, M.R.

    1986-01-01

    One hundred eight knees of 93 patients with seropositive rheumatoid arthritis and persistent synovitis of the knee were treated with an intraarticular injection of 270 mCi of dysprosium 165 bound to ferric hydroxide macroaggregate. Leakage of radioactivity from the injected joint was minimal. Mean leakage to the venous blood 3 hours after injection was 0.11% of the injected dose; this corresponds to a mean whole body dose of 0.2 rads. Mean leakage to the liver 24 hours after injection was 0.64% of the injected dose; this corresponds to a mean liver dose of 3.2 rads. In 7 additional patients examined, there was negligible or near negligible activity found in the draining inguinal lymph nodes. One-year followup was possible for 74 knees (63 patients). Sixty-one percent of the knees had good results, 23% had fair results, and 16% had poor results. There was a direct correlation between the radiographic stage and response to treatment. In knees with stage I radiographic changes, 72% showed good results; 93% showed improvement. In knees with stage II changes, 59% showed good results; 81% showed improvement. These preliminary results indicate that dysprosium 165-ferric hydroxide macroaggregate is an effective agent for radiation synovectomy. The low leakage rates observed offer a definite advantage over agents previously used

  4. Synovectomy of the rheumatoid knee using intra-articular injection of dysprosium-165-ferric hydroxide macroaggregates

    International Nuclear Information System (INIS)

    Sledge, C.B.; Zuckerman, J.D.; Shortkroff, S.; Zalutsky, M.R.; Venkatesan, P.; Snyder, M.A.; Barrett, W.P.

    1987-01-01

    One hundred and eleven patients who had seropositive rheumatoid arthritis and persistent synovitis of the knee were treated with intra-articular injection of 270 millicuries of dysprosium-165 bound to ferric hydroxide macroaggregates. A two-year follow-up was available for fifty-nine of the treated knees. Thirty-nine had a good result; nine, a fair result; and eleven, a poor result. Of the twenty-five knees that had Stage-I radiographic changes, nineteen had a good result. Of the thirty-four knees that had Stage-II radiographic changes, twenty showed a good result. Systemic spread of the radioactivity from the injected joint was minimum. The mean whole-body dose was calculated to be 0.3 rad and that to the liver twenty-four hours after injection, 3.2 rads. The results indicated that dysprosium-165-ferric hydroxide macroaggregate is an effective agent for performing radiation synovectomy, particularly in knees that have Stage-I radiographic changes. Because of the minimum rate of systemic spread of the dysprosium-165, it offers a definite advantage over agents that previously have been used

  5. Intra-articular osteoid osteoma of the calcaneus: a case report and review

    Directory of Open Access Journals (Sweden)

    Tomo Hamada, MD

    2016-09-01

    Full Text Available Osteoid osteoma of the calcaneus is rare and frequently misdiagnosed as arthritis because of similar symptoms. In addition, radiographic findings may be nonspecific, and magnetic resonance imaging (MRI may show a bone marrow edema and changes in adjacent soft tissue. A 19-year-old man presented with a 6-month history of persistent pain and swelling in the left hind foot; diagnostic computed tomography and MRI analyses revealed lesions suggesting an intra-articular osteoid osteoma of the calcaneus. Initial MRI did not show specific findings. On operation, the tumor was removed by curettage; pathologic findings demonstrated woven bone trabeculae surrounded by connective tissue, confirming the diagnosis. To the best of our knowledge, MRI scans in all cases of calcaneal osteoid osteoma reported till 3 months after the injury exhibited a nidus. We believe that calcaneal osteoid osteoma should be considered as a differential diagnosis in patients undergoing MRI 3 months after symptom presentation; early computed tomography is critical in diagnosis.

  6. Evaluation on Cartilage Morphology after Intra-Articular Injection of Titanium Dioxide Nanoparticles in Rats

    International Nuclear Information System (INIS)

    Wang, J.; Gao, Y.; Hou, Y.; Zhao, F.; Pu, F.; Liu, X.; Fan, Y.; Wu, Z.

    2012-01-01

    Nano scale wear particles would generate from orthopedic implants with nano scale surface topography because of residual stress. In this study, the effect of TiO 2 nanoparticles on articular cartilage was investigated by intra-articular injection in rats. Using contrast-enhanced high-resolution micro computed tomography (micro-CT) technology, the decreased thickness of articular cartilage in distal femur was determined at 1, 7, 14, and 30 days after nanoparticle exposure. A strong linear correlation (r=0.928, P 2 nanoparticles, cartilage thickness showed time-dependent decrease, and cartilage volume was decreased too. Further, the histopathological examination showed the edema chondrocyte and shrinked nucleus in the radial and calcified zone of cartilage. The ultrastructure of articular cartilage implied that the chondrocytes was degenerated, expressing as the condensed chromatin, the dilated endoplasmic reticulum, and the rich mitochondria. Even, the fragments of ruptured endoplasmic reticulum were observed in the cytoplasm of chondrocytes at postexposure day 30. Results indicate that potential damage of articular cartilage was induced by particles existed in knee joint and imply that the bio monitoring should be strengthened in patients with prostheses replacement.

  7. An outcomes assessment of intra-articular calcaneal fractures, using patient and physician's assessment profiles.

    LENUS (Irish Health Repository)

    Kennedy, J G

    2012-02-03

    Thirty-six patients with intra-articular displaced calcaneal fractures were examined to determine both physician- and patient-based outcomes. Three groups were selected. Group A was treated with open reduction and internal fixation, group B was treated with open reduction internal fixation and supplemental bone graft augmentation and the patients in group C were treated with plaster cast immobilisation and no formal operative treatment. All cohorts were well matched for age, sex and severity of injury. Patients were evaluated using both the American Foot and Ankle Society Scoring System (AFASS) and the short form 36 (SF-36). Minimum time to follow up was 4 years. No significant difference was observed between the three groups with regards to pain and functional outcomes using the AFASS score (P>0.05). No difference was observed between the three groups using the SF-36 score (P>0.1). A statistically significant difference was observed, using radiological criteria, between both groups A and B when compared to the non-operative group C. The rate of wound infection in groups A and B was 31.5%. No correlation was found between the SF-36 score and the AFASS score. No correlation was found between the radiological score and either the SF-36 or the AFASS score. This study has found that the conservative treatment of calcaneal fractures can produce satisfactory outcomes with lower morbidity than surgically treated fractures.

  8. Pulsed CO2 laser for intra-articular cartilage vaporization and subchondral bone perforation in horses

    Science.gov (United States)

    Nixon, Alan J.; Roth, Jerry E.; Krook, Lennart P.

    1991-05-01

    A pulsed carbon dioxide laser was used to vaporize articular cartilage in four horses, and perforate the cartilage and subchondral bone in four horses. Both intercarpal joints were examined arthroscopically and either a 1 cm cartilage crater or a series of holes was created in the third carpal bone of one joint. The contralateral carpus served as a control. The horses were evaluated clinically for 8 weeks, euthanatized and the joints examined radiographically, grossly, and histologically. Pulsed carbon dioxide laser vaporized cartilage readily but penetrated bone poorly. Cartilage vaporization resulted in no greater swelling, heat, pain on flexion, lameness, or synovial fluid reaction than the sham procedure. Laser drilling resulted in a shallow, charred hole with a tenacious carbon residue, and in combination with the thermal damage to deeper bone, resulted in increased swelling, mild lameness and a low-grade, but persistent synovitis. Cartilage removal by laser vaporization resulted in rapid regrowth with fibrous and fibrovascular tissue and occasional regions of fibrocartilage at week 8. The subchondral bone, synovial membrane, and draining lymph nodes appeared essentially unaffected by the laser cartilage vaporization procedure. Conversely, carbon dioxide laser drilling of subchondral bone resulted in poor penetration, extensive areas of thermal necrosis of bone, and significant secondary damage to the apposing articular surface of the radial carpal bone. The carbon dioxide laser is a useful intraarticular instrument for removal of cartilage and has potential application in inaccessible regions of diarthrodial joints. It does not penetrate bone sufficiently to have application in subchondral drilling.

  9. The anterior approach for a non-image-guided intra-articular hip injection.

    Science.gov (United States)

    Mei-Dan, Omer; McConkey, Mark O; Petersen, Brian; McCarty, Eric; Moreira, Brett; Young, David A

    2013-06-01

    The purpose of this study was to investigate and validate the accuracy and safety of a technique using an anterior approach for non-image-guided intra-articular injection of the hip by use of anatomic landmarks. We enrolled 55 patients. Injections were performed before supine hip arthroscopy after landmarking and before application of traction. After the needle insertion, success was confirmed with an air arthrogram and by direct visualization after arthroscope insertion. Accuracy and difficulty achieving correct needle placement were correlated with age, weight, height, body mass index, body type, gender, and surgical indication, as well as femoral and pelvic morphology. Forty-five patients who underwent injection in the office were followed up separately to document injection side effects. Needle placement accuracy was correlated to patients' demographics. All statistical tests with P values were 2 sided, with the level of significance set at P injections by use of the direct anterior approach, from the intersection of the lines drawn from the anterior superior iliac spine and 1 cm distal to the tip of the greater trochanter, are safe and reproducible. Patient characteristics, such as increased subcutaneous adipose tissue or osseous anatomic variants, can lead to difficulty in placing the needle successfully. These characteristics can be predicted with the aid of physical examination and careful study of the pelvic radiographs. Level IV, therapeutic case series. Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  10. Fluoroscopically Guided Sacroiliac Joint Injections: Comparison of the Effects of Intraarticular and Periarticular Injections on Immediate and Short-Term Pain Relief.

    Science.gov (United States)

    Nacey, Nicholas C; Patrie, James T; Fox, Michael G

    2016-11-01

    The purpose of this study was to determine whether intraarticular sacroiliac joint injections provide greater immediate and short-term pain relief than periarticular sacroiliac joint injections do. The records of all fluoroscopically guided sacroiliac joint injections performed over a 4-year period were identified. Patients who received an injection of 0.5 mL of bupivacaine and 0.5 mL (20 mg) of triamcinolone and who had preinjection, immediate, and 1-week postinjection pain scores (0-10 numeric scale) were included. Images from the procedures were retrospectively reviewed by two musculoskeletal radiologists to determine intraarticular or periarticular administration of the injection with discrepancies resolved by consensus. One hundred thirteen injections in 99 patients (65 women, 34 men; mean age, 59.4 years) met the inclusion criteria. There were 55 intraarticular and 58 periarticular injections. The mean preinjection, immediate, and 1-week postinjection pain scores for the intraarticular injections were 6.0, 1.6, and 4.1 and for the periarticular injections were 6.1, 2.0, and 4.2. The mean immediate and 1-week postinjection pain reduction were statistically significant in both groups (p sacroiliac joint injections provide statistically significant immediate and 1-week postinjection pain relief, no significant difference in the degree of pain relief achieved with intraarticular and periarticular injections was noted.

  11. Fluoroscopy-guided intrA-articular facet joint steroid injection for the management of low back pain: Therapeutic effectiveness and arthrographic pattern

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Su Jin; Lee, Jun Woo; Lee, Guen Young; You, Ja Yeon; Kang, Heung Sik [Dept. of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (Korea, Republic of); Chai, Jae Won [Dept. of Radiology, SMG-SNU Boramae Medical Center, Seoul (Korea, Republic of); Ahn, Joong Mo [Dept. of Radiology, University of Pittsburgh Medical Center, Pittsburgh (United States)

    2015-09-15

    To evaluate the effectiveness of fluoroscopy-guided intra-articular facet joint steroid injection for the management of low back pain, and to document the incidence of epidural leakage. In total, 320 facet joint injections of 244 consecutive patients were included in this study. All patients had undergone an intra-articular facet joint steroid injection in 2007 and had follow-up post-treatment medical records. The response to treatment was analyzed on the basis of chart documentation (aggravated, no change, slightly improved, much improved, no pain). Fluoroscopic arthrograms of the injections were retrospectively analyzed by two radiologists. Of the 244 patients, 85.2% (n = 208) showed improvement after an initial intra-articular facet joint steroid injection. A total of 77.9% (n = 162) of the patients showed symptom recurrence, with a median of a 69 day symptom-free interval, while 30.3% (n = 74) of the patients showed symptom-free intervals of more than six months. Overall, 74 (33.3%) of the 222 cases of intra-articular facet joint steroid injections without concomitant epidural steroid injection showed epidural leakage in fluoroscopic arthrograms. Fluoroscopy-guided intra-articular facet joint injection is a reliable technique for the management of low back pain, with excellent immediate effectiveness and good prolonged (> 2 months) pain relief. Epidural leakage during injection was detected in one-third of the cases.

  12. Exploring reasons for the observed inconsistent trial reports on intra-articular injections with hyaluronic acid in the treatment of osteoarthritis: Meta-regression analyses of randomized trials.

    Science.gov (United States)

    Johansen, Mette; Bahrt, Henriette; Altman, Roy D; Bartels, Else M; Juhl, Carsten B; Bliddal, Henning; Lund, Hans; Christensen, Robin

    2016-08-01

    The aim was to identify factors explaining inconsistent observations concerning the efficacy of intra-articular hyaluronic acid compared to intra-articular sham/control, or non-intervention control, in patients with symptomatic osteoarthritis, based on randomized clinical trials (RCTs). A systematic review and meta-regression analyses of available randomized trials were conducted. The outcome, pain, was assessed according to a pre-specified hierarchy of potentially available outcomes. Hedges׳s standardized mean difference [SMD (95% CI)] served as effect size. REstricted Maximum Likelihood (REML) mixed-effects models were used to combine study results, and heterogeneity was calculated and interpreted as Tau-squared and I-squared, respectively. Overall, 99 studies (14,804 patients) met the inclusion criteria: Of these, only 71 studies (72%), including 85 comparisons (11,216 patients), had adequate data available for inclusion in the primary meta-analysis. Overall, compared with placebo, intra-articular hyaluronic acid reduced pain with an effect size of -0.39 [-0.47 to -0.31; P hyaluronic acid. Based on available trial data, intra-articular hyaluronic acid showed a better effect than intra-articular saline on pain reduction in osteoarthritis. Publication bias and the risk of selective outcome reporting suggest only small clinical effect compared to saline. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Fluoroscopy-guided intrA-articular facet joint steroid injection for the management of low back pain: Therapeutic effectiveness and arthrographic pattern

    International Nuclear Information System (INIS)

    Kim, Su Jin; Lee, Jun Woo; Lee, Guen Young; You, Ja Yeon; Kang, Heung Sik; Chai, Jae Won; Ahn, Joong Mo

    2015-01-01

    To evaluate the effectiveness of fluoroscopy-guided intra-articular facet joint steroid injection for the management of low back pain, and to document the incidence of epidural leakage. In total, 320 facet joint injections of 244 consecutive patients were included in this study. All patients had undergone an intra-articular facet joint steroid injection in 2007 and had follow-up post-treatment medical records. The response to treatment was analyzed on the basis of chart documentation (aggravated, no change, slightly improved, much improved, no pain). Fluoroscopic arthrograms of the injections were retrospectively analyzed by two radiologists. Of the 244 patients, 85.2% (n = 208) showed improvement after an initial intra-articular facet joint steroid injection. A total of 77.9% (n = 162) of the patients showed symptom recurrence, with a median of a 69 day symptom-free interval, while 30.3% (n = 74) of the patients showed symptom-free intervals of more than six months. Overall, 74 (33.3%) of the 222 cases of intra-articular facet joint steroid injections without concomitant epidural steroid injection showed epidural leakage in fluoroscopic arthrograms. Fluoroscopy-guided intra-articular facet joint injection is a reliable technique for the management of low back pain, with excellent immediate effectiveness and good prolonged (> 2 months) pain relief. Epidural leakage during injection was detected in one-third of the cases

  14. Oxigênio suplementar e incidência de náuseas e vômitos perioperatórios no parto cesariano sob anestesia subaracnoidea Oxígeno suplementario e incidencia de náuseas y vómitos perioperatorios en el parto cesariano bajo anestesia subaracnoidea Supplemental oxygen and the incidence of perioperative nausea and vomiting in cesarean sections under subarachnoid block

    Directory of Open Access Journals (Sweden)

    Fernanda Salomão Turazzi Pécora

    2009-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Oxigênio suplementar pode reduzir a incidência de náuseas e vômitos pós-operatórios em pacientes submetidos à anestesia geral. O objetivo deste estudo foi testar a eficácia do oxigênio suplementar durante a cesariana eletiva sob anestesia subaracnoidea em diminuir a incidência de náuseas e vômitos perioperatórios. MÉTODO: Após indução de anestesia subaracnoidea padronizada, noventa e quatro parturientes submetidas ao parto operatório foram distribuídas de forma aleatória para receberem, através de cateter nasal tipo óculos, 4 L.min-1 de oxigênio (Grupo O ou ar comprimido (Grupo S até o final do procedimento. As pacientes foram inquiridas acerca da ocorrência de náuseas e vômitos durante a operação e nas primeiras seis e 24 horas de pós-parto. RESULTADOS: Os dois grupos mostraram-se comparáveis quanto às variáveis demográficas, perioperatórias e quanto aos dados do recém-nascido. No Grupo O, a incidência de náusea durante a operação nas primeiras 6 horas de pós-operatório e entre 6 e 24 horas de pós-operatório foi de 35%, 20% e 13%, respectivamente, enquanto no Grupo S foi de 35%, 30% e 19%, respectivamente. A incidência de vômito no Grupo O foi de 9%, 11% e 6% nos períodos correspondentes e no Grupo S 21%, 7% e 7%, respectivamente. Essas diferenças não foram significativas. CONCLUSÕES: Na população estudada, a oxigenoterapia suplementar desde a indução da anestesia até o término da operação não reduziu a incidência de náuseas ou vômitos intraoperatórios e pós-operatórios em mulheres submetidas ao parto cesariano sob anestesia subaracnoidea.JUSTIFICATIVA Y OBJETIVOS: El oxígeno suplementario puede reducir la incidencia de náuseas y vómitos postoperatorios en pacientes sometidos a la anestesia general. El objetivo de este estudio, fue comprobar la eficacia del oxígeno suplementario durante la cesárea electiva bajo anestesia subaracnoidea, para reducir

  15. The effect of intra-articular injection of ultracain in the temporomandibular joint in patients with preauricular pain - A randomized prospective double-blind placebo-controlled crossover study

    NARCIS (Netherlands)

    Tjakkes, Geerten-Has E.; TenVergert, Elisabeth M.; de Bont, Lambert G. M.; Stegenga, Boudewijn

    2007-01-01

    Objectives: To evaluate the distinguishing ability of intraarticular anesthesia from placebo in orofacial pain patients with pain located in the temporomandibular joint (TMJ) region, aiming at a validation of intra-articular anesthesia injection as a diagnostic test of pain in the TMJ region.

  16. Estudo comparativo entre bupivacaína a 0,5% e mistura enantiomérica de bupivacaína (S75-R25 a 0,5% em anestesia peridural Estudio comparativo entre bupivacaína a 0,5% y mezcla enantiomérica de bupivacaína (S75-R25 a 0,5% en anestesia peridural Comparative study between 0.5% bupivacaine and 0.5% enantiomeric mixture of bupivacaine (S75-R25 in epidural anesthesia

    Directory of Open Access Journals (Sweden)

    Rosane Fossatti Gonçalves

    2003-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A mistura enantiomérica de bupivacaína (S75-R25 vem sendo empregada pela sua propriedade anestésica com menor toxicidade do que a bupivacaína racêmica. O objetivo deste estudo é comparar a bupivacaína a 0,5% com a mistura enantiomérica de bupivacaína a 0,5% (S75-R25 em anestesia peridural. MÉTODO: Foram incluídos no estudo 44 pacientes divididos em dois grupos (n=22 denominados de Bupivacaína e S75-R25. Os pacientes foram medicados com midazolam por via venosa. A anestesia peridural foi realizada no espaço L3-L4 ou L2-L3, e administrado 16 a 24 ml da solução do anestésico local. O grupo Bupivacaína recebeu bupivacaína a 0,5% com vasoconstritor. O grupo S75-R25 recebeu a mistura enantiomérica de bupivacaína a 0,5% com vasoconstritor. Foram avaliados a temperatura do membro inferior antes e após o bloqueio peridural, o tempo de latência do bloqueio, o tipo de alteração referida pelo paciente, possíveis falhas sensoriais, nível sensorial metamérico e o grau de bloqueio motor. Na sala de recuperação pós-anestésica, foi anotado o tempo de requisição do primeiro analgésico. RESULTADOS: Fizeram parte da avaliação final 41 pacientes. Os grupos foram demograficamente semelhantes. A dose per-operatória de midazolam, o volume de anestésico local por via peridural, o tempo de latência para a instalação do bloqueio, falhas sensoriais a picada da agulha, temperatura do membro inferior nos diferentes tempos, o tipo de sensação parestésica, e o nível anestésico em dermátomos foram semelhantes entre os grupos. O grau de bloqueio motor foi mais intenso para o grupo Bupivacaína, comparado ao grupo S75-R25 (p = 0,0117. O tempo para requisição do primeiro analgésico no período pós-operatório foi superior para o grupo S75-R25, comparado ao grupo Bupivacaína (596 ± 436 minutos versus 463 ± 270 minutos, respectivamente; p = 0,04572. A incidência de efeitos adversos foi semelhante entre

  17. Protocolo y necesidad de kit para toxicidad sistémica por anestésicos locales

    OpenAIRE

    Berrío Valencia, Marta Inés; Vargas Silva, Juan Felipe

    2013-01-01

    La intoxicación sistémica por anestésicos locales es una de las complicaciones más temidas en la anestesia regional por su potencial tóxico cardiaco, neurológico y principalmente por el riesgo de desencadenar paro cardiorrespiratorio de difícil manejo, aun en pacientes sanos. La prevención como la primera meta, seguida de un rápido reconocimiento y tratamiento oportuno basado en diversas medidas generales y luego del tratamiento específico con las emulsiones lipídicas al 20%, permiten mejorar...

  18. Aplicação do monitor Narcotrend® para avaliar a profundidade da anestesia em crianças submetidas à cirurgia cardíaca: estudo prospectivo e controlado Aplicación del monitor Narcotrend® para evaluar la profundidad de la anestesia en niños sometidos a la cirugía cardíaca: estudio prospectivo y controlado Application of Narcotrend® monitor for evaluation of depth of anesthesia in infants undergoing cardiac surgery: a prospective control study

    Directory of Open Access Journals (Sweden)

    Yiyan Jiang

    2013-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Investigar a eficácia clínica, segurança e viabilidade do monitor Narcotrend® para avaliar a profundidade da anestesia em crianças com doença cardíaca congênita (DCC submetidas à cirurgia cardíaca. MÉTODOS: Foram randomicamente selecionadas 80 crianças submetidas à anestesia geral em cirurgia seletiva. As crianças foram divididas em dois grupos de forma aleatória (n = 40 por grupo. No grupo Narcotrend, a profundidade da anestesia foi monitorada com o Narcotrend. No grupo padrão, a profundidade da anestesia foi controlada de acordo com a experiência clínica. A pressão arterial média (PAM e a frequência cardíaca (FC foram determinadas e a dose de fentanil e relaxante muscular e os tempos de recuperação e de extubação foram registrados. RESULTADOS: Em ambos os grupos, os sinais vitais apresentaram-se estáveis durante a cirurgia. No grupo Narcotrend, a PAM e a FC foram mais estáveis, a dose total de fentanil e relaxante muscular significativamente menor e os tempos de recuperação e extubação acentuadamente mais reduzidos em comparação com o grupo padrão. CONCLUSÃO: A aplicação do monitor Narcotrend para medir a profundidade da anestesia foi útil para controlar a profundidade da anestesia em crianças com DCC que receberam anestesia intravenosa total, na qual uma pequena quantidade de narcóticos pode obter a anestesia ideal. Além disso, os tempos de recuperação e extubação foram menores e os efeitos secundários, como sensibilização intraoperatória, puderam ser evitados.JUSTIFICATIVA Y OBJETIVOS: Investigar la eficacia clínica, la seguridad y la viabilidad del monitor Narcotrend® para evaluar la profundidad de la anestesia en niños con enfermedad cardíaca congénita (ECC sometidos a la cirugía cardíaca. MÉTODOS: Un total de 80 niños sometidos a la anestesia general en cirugía selectiva fueron seleccionados aleatoriamente. Los niños fueron divididos en dos grupos de

  19. Estudo comparativo da analgesia entre bupivacaína e morfina intra-articular em osteoartrite de joelho Estudio comparativo de la analgesia entre bupivacaína y morfina intra-articular en osteoartritis de la rodilla Intra-articular bupivacaine and morphine for knee osteoarthritis analgesia. Comparative study

    Directory of Open Access Journals (Sweden)

    Miriam C B Gazi

    2005-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A osteoartrite é a mais freqüente entre as doenças articulares em pessoas idosas. O objetivo do estudo foi comparar o efeito analgésico da bupivacaína e da morfina por via intra-articular em pacientes portadores de osteoartrite de joelho. MÉTODO: Foram avaliados 39 pacientes em estudo duplamente encoberto, divididos de forma aleatória, em dois grupos: os do G1 (n = 18 receberam 1 mg (1 mL de morfina diluída em 9 mL de solução fisiológica a 0,9% e os do G2 (n = 21, 25 mg (10 mL de bupivacaína a 0,25% sem vasoconstritor, por via intra-articular. A intensidade da dor foi avaliada pela escala numérica e verbal nos momentos 0, 30, 60 minutos e 7 dias, em repouso e em movimento. Foram avaliados a necessidade de complementação analgésica com paracetamol (500 mg, a dose total de analgésico utilizado, a duração da analgesia e a qualidade da analgesia (pelo paciente. RESULTADOS: Dos 39 pacientes, 31 completaram o estudo. Não houve diferença significativa da intensidade da dor em repouso e em movimento entre os dois grupos nos momentos estudados. Não houve diferença entre os dois grupos no tempo entre a administração da solução e a necessidade de complementação analgésica. A dose média do paracetamol utilizada no primeiro dia da semana foi de 796 mg do G1 e de 950 mg no G2; a complementação na semana foi de 3578 mg no G1 e 5333 mg no G2. CONCLUSÕES: O efeito analgésico de 1 mg de morfina e de 25 mg de bupivacaína a 0,25% sem vasoconstritor intra-articular foram semelhantes.JUSTIFICATIVA Y OBJETIVOS: La osteoartritis es la más frecuente entre las enfermedades articulares en personas de edad. El objetivo del estudio fue comparar el efecto analgésico de la bupivacaína y de la morfina por vía intra-articular en pacientes portadores de osteoartritis de rodilla. MÉTODO: Fueron evaluados 39 pacientes en estudio doblemente encubierto, divididos de forma aleatoria, en dos grupos: los del G1 (n = 18

  20. Appropriateness of clinical and organizational criteria for intra-articular injection therapies in osteoarthritis: A Delphi method consensus initiative among experts in Italy

    Directory of Open Access Journals (Sweden)

    Marco Paoloni

    2015-06-01

    Full Text Available OBJECTIVE: The aim of the study was to identify the main aspects involved in patient selection, the choice of therapeutic agents and the safety profile, as well as the medico-legal and organizational aspects of intra-articular injection therapies for osteoarthritis. METHODS: A committee of 10 experts from Italian universities, public hospitals, territorial services, research institutes and patient associations was set up. Fifty-two clinicians from a large number of Italian medical centers specialized in intra-articular injection therapy took part in a Delphi process aimed at obtaining consensus statements among the participants. RESULTS: Large consensus was obtained for statements grouped under the following main themes: treatment indications; drug/medical device choice; treatment efficacy; and appropriate setting. CONCLUSIONS: The consensus statements developed by a large number of experts may be used as a practical reference tool to help physicians treat osteoarthritis patients by means of intra-articular injection therapies.

  1. Intra-articular hyaluronan is without clinical effect in knee osteoarthritis: a multicentre, randomised, placebo-controlled, double-blind study of 337 patients followed for 1 year

    DEFF Research Database (Denmark)

    Jørgensen, Anette; Stengaard-Pedersen, Kristian; Simonsen, Ole

    2010-01-01

    OBJECTIVE: To examine the long-term efficacy and safety of five intra-articular injections with hyaluronan in knee osteoarthritis. METHODS: A multicentre, randomised, placebo-controlled double-blind study of 337 patients fulfilling the American College of Rheumatology (ACR) criteria for knee...... osteoarthritis (clinical and laboratory) and with a Lequesne algofunctional index score (LFI) of 10 or greater. Patients received a hyaluronan product (sodium hyaluronate; Hyalgan) (n=167) or saline (n=170) intra-articularly weekly for 5 weeks and were followed up to 1 year. Time to recurrence was the primary...... the ACR criteria for osteoarthritis of the knee with moderate to severe disease activity (LFI > or = 10), five intra-articular injections of hyaluronan did not improve pain, function, paracetamol consumption or other efficacy parameters 3, 6, 9 and 12 months after the treatment....

  2. A Case Report of Intra-articular Bee Venom Pharmacopuncture combining with oriental medical treatment for Acute Traumatic Partial Tear of Meniscus.

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    Lee Jae-Hoon

    2010-12-01

    Full Text Available This case was report of intra-articular bee venom pharmacopuncture injection on the patient with Acute Traumatic Partial tear of meniscus. We used intra-articular bee venom pharmacopuncture injection to Acute Traumatic Partial tear of meniscus diagnosed by symptoms and MR imaging. Be under treatment if necessary we prescribed herbal medication and physiotherapy. The state of patient was measured by Visual Analog Scale(VAS and Walking time and Western Ontario and McMaster Universities(WOMAC Index score. After several times of treatments, noticeable reduction of pain was measured and increased time of walking on floor and decreased WOMAC score. This results suggest that intra-articular bee venom pharmacopuncture injection are effective to treatments of Acute Traumatic Partial tear of meniscus.

  3. Clinical and ultrasonographic features associated to response to intraarticular corticosteroid injection. A one year follow up prospective cohort study in knee osteoarthritis patient with joint effusion

    Science.gov (United States)

    Galisteo, Carlos; García-Manrique, María; Navarro, Noemí; Caixàs, Assumpta; Larrosa, Marta; Gratacós, Jordi

    2018-01-01

    Objectives Intraarticular injection is used for pain relief in knee osteoarthritis (OA), but there is not a well defined profile of patient who could get more benefit from it. The purpose of this study was to evaluate the frequency of pain relief at one year after corticosteroids intraarticular injection and to identify clinical factors associated to response in patients with knee osteoarthritis with joint effusion. Methods One-year prospective cohort study of patients with knee OA with joint effusion confirmed by ultrasound. An intraarticular injection was performed following a clinical protocol. Anthropometric measurements, laboratory parameters, clinical severity, ultrasound parameters and radiological severity were collected. Response regarding pain and presence of synovial fluid on ultrasound at one month and at one year were evaluated. Clinical responder were consider in subjects with enough improvement to carry out normal daily activities with pain VASeffusion. PMID:29351562

  4. Agitação no despertar da anestesia em crianças: aspectos atuais Emergence agitation in pediatric anesthesia: current features

    Directory of Open Access Journals (Sweden)

    Leopoldo Muniz da Silva

    2008-04-01

    Full Text Available OBJETIVO: A agitação pós-operatória é um fenômeno clínico bem documentado em crianças, com incidência variando de 10 a 67%. Não existe explicação definitiva para a agitação no despertar. Várias causas têm sido discutidas na literatura, como rápido retorno à consciência em ambiente não familiar, presença de dor (ferida, dor de garganta, distensão vesical, etc., estresse na indução, hipoxemia, obstrução da via aérea, ambiente barulhento, duração da anestesia, temperamento da criança, uso de medicação pré-anestésica e técnica anestésica empregada. O objetivo deste estudo é discutir as possíveis causas da agitação pós-operatória em crianças, subsidiando ações referentes à identificação e prevenção mais adequada. FONTES DOS DADOS: Artigos originais e revisões, publicados no período de 1991 a 2007 e indexados no MEDLINE e PubMed, utilizando as seguintes palavras-chave: agitação no despertar, incidência, etiologia, diagnóstico, tratamento, criança, anestesia pediátrica. SÍNTESE DOS DADOS: É apresentada neste artigo uma revisão de possíveis desencadeadores de agitação, assim como uma proposta de escala para uniformização adequada do diagnóstico e medidas que implementam a prevenção e o tratamento. CONCLUSÕES: Nenhum fator pode, de maneira isolada, ser implicado como causador de agitação pós-operatória, devendo ser considerada como uma síndrome com componentes biológicos, farmacológicos, psicológicos e sociais, os quais o anestesiologista e o pediatra intensivista devem estar preparados para identificar, prevenir e intervir adequadamente quando necessário.OBJECTIVE: Postoperative agitation in children is a well-documented clinical phenomenon with incidence ranging from 10% to 67%. There is no definitive explanation for this agitation. Possible causes include rapid awakening in unfamiliar settings, pain (wounds, sore throat, bladder distension, etc., stress during induction

  5. Anestesia do pirarucu por aspersão da benzocaína diretamente nas brânquias Anesthesia in pirarucu by benzocaine sprays in the gills

    Directory of Open Access Journals (Sweden)

    Alexandre Honczaryk

    2010-02-01

    Full Text Available O pirarucu (Arapaima gigas é um peixe que pode atingir mais de 2m e 100kg. No entanto, por ser um animal de grande porte, o risco de acidentes é bastante elevado durante o manejo. Logo, anestésicos são essenciais para segurança no trabalho. Nesse contexto, estudou-se a possibilidade do uso da benzocaína aspergida diretamente nas brânquias do pirarucu, para indução à anestesia do peixe pulmonado da Amazônia sem riscos de afogamento. Foram testadas as concentrações de 25, 50 e 75mg L-1 em indivíduos adultos (55,1±7,0kg e 1,80±0,1m e as concentrações de 50 e 100mg L-1 em juvenis (6,0±0,6kg e 87,2±5,6cm. Os resultados mostram viabilidade do uso da benzocaína aspergida diretamente nas brânquias do pirarucu em concentrações de 50 a 100mg L-1, proporcionando anestesia com ausência de movimentação por aproximadamente 2min, tempo suficiente para procedimentos rápidos, como biometria, injeções, marcação, coleta de raspados de muco na superfície do corpo e brânquias. Mortalidade de animais não foi observada mesmo um mês após os testes.Pirarucu (Arapaima gigas is a fish that may achieve more than 2m and 100kg. Thus handling of this fish may impose risks to workers. In this way, anesthetics are imperative for safety at work, but usual anesthetics baths are not feasible for pirarucu because of the fish size and the species pulmonary respiration. Pirarucu may die drowned if submersed as the other fishes in anesthetics baths. Therefore, this work tested the possible use of benzocaine directly sprinkled in the gills of pirarucu. In the first experiment, benzocaine solutions in concentrations of 25, 50 and 75mg L-1 were tested for adult fish (55.1±7.0kg e 1.80±0.1m. In the second one, the anesthetic in concentrations of 50 and 100mg L-1 were tested for juveniles (6.0±0.6kg e 87.2±5.6cm. Benzocaine sprinkled directly in the gills of pirarucu showed to be an efficient anesthetic both for juveniles and adult fish. It was

  6. Local anesthetics and nuclear medical bone images of the equine fore limb

    International Nuclear Information System (INIS)

    Gaughan, E.M.; Wallace, R.J.; Kallfelz, F.A.

    1990-01-01

    The effects of two local anesthetic agents on the diagnostic quality of nuclear medical bone images (NMBIs) of distal parts of the equine fore limb were investigated. Local effects on bone uptake of technetium 99m methylene diphosphonate (99mTc-MDP) 4 and 24 hours after perineural and intraarticular injection of mepivacaine hydrochloride and bupivacaine hydrochloride were evaluated in the carpal and metacarpophalangeal regions of 12 horses and ponies. Neither mepivacaine hydrochloride nor bupivacaine hydrochloride significantly altered the diagnostic quality of the NMBIs. The injection and subsequent action of local anesthetics do not appear to influence local bone uptake of 99mTc-MDP significantly

  7. Is intra-articular pathology associated with MCL edema on MR imaging of the non-traumatic knee?

    International Nuclear Information System (INIS)

    Blankenbaker, Donna G.; De Smet, Arthur A.; Fine, Jason P.

    2005-01-01

    Edema surrounding the medial collateral ligament (MCL) is seen on MR imaging in patients with MCL injuries and in patients with radiographic osteoarthritis in the non-traumatic knee. Because we noted MCL edema in patients without prior trauma or osteoarthritis, we studied the association between intra-articular pathology and MCL edema in patients without knee trauma. We evaluated the MR examinations of 247 consecutive patients (121 male, 126 female with a mean age of 44 years) without recent trauma for the presence of edema surrounding the MCL, meniscal and ACL tears, medial meniscal extrusion, medial compartment chondromalacia, and osteoarthritis. The percentages of patients illustrating MCL edema with and without each type of pathology were compared using Fisher's exact test to determine if there was a statistically significant association. We found MCL edema in 60% of 247 patients. MCL edema was present in 67% of patients with medial meniscal tears, 35% with lateral meniscal tears, 100% with meniscal extrusion of 3 mm or more, 78% with femoral chondromalacia, 82% with tibial chondromalacia, and 50% with osteoarthritis. The percentage of patients with edema increased with the severity of the chondromalacia. These associations were all statistically significant (p <0.02). The mean age of those with MCL edema was 49.7 years compared with 34.9 years without MCL edema (p <0.001). Patient gender and ACL tear did not correlate with MCL edema. Nine (4%) of the 247 patients had MCL edema without intra-articular pathology. None of these 9 patients had MCL tenderness or joint laxity on physical examination. We confirmed that MCL edema is associated with osteoarthritis, but is also associated with meniscal tears, meniscal extrusion, and chondromalacia. In addition, MCL edema can be seen in patients without intra-articular pathology, recent trauma or MCL abnormality on physical examination. (orig.)

  8. Is intra-articular pathology associated with MCL edema on MR imaging of the non-traumatic knee?

    Energy Technology Data Exchange (ETDEWEB)

    Blankenbaker, Donna G.; De Smet, Arthur A. [University of Wisconsin Medical School, Division of Musculoskeletal Imaging, Department of Radiology, Madison (United States); Fine, Jason P. [University of Wisconsin, Department of Statistics, Madison (United States); University of Wisconsin, Department of Biostatistics and Informatics, Madison (United States)

    2005-08-01

    Edema surrounding the medial collateral ligament (MCL) is seen on MR imaging in patients with MCL injuries and in patients with radiographic osteoarthritis in the non-traumatic knee. Because we noted MCL edema in patients without prior trauma or osteoarthritis, we studied the association between intra-articular pathology and MCL edema in patients without knee trauma. We evaluated the MR examinations of 247 consecutive patients (121 male, 126 female with a mean age of 44 years) without recent trauma for the presence of edema surrounding the MCL, meniscal and ACL tears, medial meniscal extrusion, medial compartment chondromalacia, and osteoarthritis. The percentages of patients illustrating MCL edema with and without each type of pathology were compared using Fisher's exact test to determine if there was a statistically significant association. We found MCL edema in 60% of 247 patients. MCL edema was present in 67% of patients with medial meniscal tears, 35% with lateral meniscal tears, 100% with meniscal extrusion of 3 mm or more, 78% with femoral chondromalacia, 82% with tibial chondromalacia, and 50% with osteoarthritis. The percentage of patients with edema increased with the severity of the chondromalacia. These associations were all statistically significant (p <0.02). The mean age of those with MCL edema was 49.7 years compared with 34.9 years without MCL edema (p <0.001). Patient gender and ACL tear did not correlate with MCL edema. Nine (4%) of the 247 patients had MCL edema without intra-articular pathology. None of these 9 patients had MCL tenderness or joint laxity on physical examination. We confirmed that MCL edema is associated with osteoarthritis, but is also associated with meniscal tears, meniscal extrusion, and chondromalacia. In addition, MCL edema can be seen in patients without intra-articular pathology, recent trauma or MCL abnormality on physical examination. (orig.)

  9. Combination of Intra-Articular and Intraosseous Injections of Platelet Rich Plasma for Severe Knee Osteoarthritis: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Mikel Sánchez

    2016-01-01

    Full Text Available The aim of this study was to assess a novel approach to treating severe knee osteoarthritis by targeting synovial membrane, superficial articular cartilage, synovial fluid, and subchondral bone by combining intra-articular injections and intraosseous infiltrations of platelet rich plasma. We explored a new strategy consisting of intraosseous infiltrations of platelet rich plasma into the subchondral bone in combination with the conventional intra-articular injection in order to tackle several knee joint tissues simultaneously. We assessed the clinical outcomes through osteoarthritis outcome score (KOOS and the inflammatory response by quantifying mesenchymal stem cells in synovial fluid. There was a significant pain reduction in the KOOS from baseline (61.55±14.11 to week 24 (74.60±19.19, after treatment (p=0.008, in the secondary outcomes (symptoms, p=0.004; ADL, p=0.022; sport/rec., p=0.017; QOL, p=0.012, as well as VAS score (p<0.001 and Lequesne Index (p=0.008. The presence of mesenchymal stem cells in synovial fluid and colony-forming cells one week after treatment decreased substantially from 7.98±8.21 MSC/μL to 4.04±5.36 MSC/μL (p=0.019 and from 601.75±312.30 to 139.19±123.61  (p=0.012, respectively. Intra-articular injections combined with intraosseous infiltrations of platelet rich plasma reduce pain and mesenchymal stem cells in synovial fluid, besides significantly improving knee joint function in patients with severe knee osteoarthritis. This trial is registered on EudraCT with the number 2013-003982-32.

  10. Treatment of athletes with symptomatic intra-articular hip pathology and athletic pubalgia/sports hernia: a case series.

    Science.gov (United States)

    Larson, Christopher M; Pierce, Bradley R; Giveans, M Russell

    2011-06-01

    The purpose of the study was to evaluate the results of surgical treatment in athletes with associated intra-articular hip pathology and extra-articular sports pubalgia. Between December 2003 and September 2009, 37 hips (mean patient age, 25 years) were diagnosed with both symptomatic athletic pubalgia and symptomatic intra-articular hip joint pathology. There were 8 professional athletes, 15 collegiate athletes, 5 elite high school athletes, and 9 competitive club athletes. Outcomes included an evaluation regarding return to sports and modified Harris Hip Score, Short Form 12 score, and visual analog scale score. We evaluated 37 hips at a mean of 29 months (range, 12 to 78 months) after the index surgery. Thirty-one hips underwent thirty-five athletic pubalgia surgeries. Hip arthroscopy was performed in 32 hips (30 cases of femoroacetabular impingement treatment, 1 traumatic labral tear, and 1 borderline dysplasia). Of 16 hips that had athletic pubalgia surgery as the index procedure, 4 (25%) returned to sports without limitations, and 11 (69%) subsequently had hip arthroscopy at a mean of 20 months after pubalgia surgery. Of 8 hips managed initially with hip arthroscopy alone, 4 (50%) returned to sports without limitations, and 3 (43%) had subsequent pubalgia surgery at a mean of 6 months after hip arthroscopy. Thirteen hips had athletic pubalgia surgery and hip arthroscopy at one setting. Concurrent or eventual surgical treatment of both disorders led to improved postoperative outcomes scores (P pubalgia or intra-articular hip pathology in this patient population, outcomes were suboptimal. Surgical management of both disorders concurrently or in a staged manner led to improved postoperative outcomes scoring and an unrestricted return to sporting activity in 89% of hips. Level IV, therapeutic case series. Copyright © 2011 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  11. Disposition of isoflupredone acetate in plasma, urine and synovial fluid following intra-articular administration to exercised Thoroughbred horses.

    Science.gov (United States)

    Knych, Heather K; Harrison, Linda M; White, Alexandria; McKemie, Daniel S

    2016-01-01

    The use of isoflupredone acetate in performance horses and the scarcity of published pharmacokinetic data necessitate further study. The objective of the current study was to describe the plasma pharmacokinetics of isoflupredone acetate as well as time-related urine and synovial fluid concentrations following intra-articular administration to horses. Twelve racing-fit adult Thoroughbred horses received a single intra-articular administration (8 mg) of isoflupredone acetate into the right antebrachiocarpal joint. Blood, urine and synovial fluid samples were collected prior to and at various times up to 28 days post drug administration. All samples were analyzed using liquid chromatography-Mass Spectrometry. Plasma data were analyzed using a population pharmacokinetic compartmental model. Maximum measured plasma isoflupredone concentrations were 1.76 ± 0.526 ng/mL at 4.0 ± 1.31 h and 1.63 ± 0.243 ng/mL at 4.75 ± 0.5 h, respectively, for horses that had synovial fluid collected and for those that did not. The plasma beta half-life was 24.2 h. Isoflupredone concentrations were below the limit of detection in all horses by 48 h and 7 days in plasma and urine, respectively. Isoflupredone was detected in the right antebrachiocarpal and middle carpal joints for 8.38 ± 5.21 and 2.38 ± 0.52 days, respectively. Results of this study provide information that can be used to regulate the use of intra-articular isoflupredone in the horse. Copyright © 2015 John Wiley & Sons, Ltd.

  12. Disposition of methylprednisolone acetate in plasma, urine, and synovial fluid following intra-articular administration to exercised thoroughbred horses.

    Science.gov (United States)

    Knych, H K; Harrison, L M; Casbeer, H C; McKemie, D S

    2014-04-01

    Methylprednisolone acetate (MPA) is commonly administered to performance horses, and therefore, establishing appropriate withdrawal times prior to performance is critical. The objectives of this study were to describe the plasma pharmacokinetics of MPA and time-related urine and synovial fluid concentrations following intra-articular administration to sixteen racing fit adult Thoroughbred horses. Horses received a single intra-articular administration of MPA (100 mg). Blood, urine, and synovial fluid samples were collected prior to and at various times up to 77 days postdrug administration and analyzed using tandem liquid chromatography-mass spectrometry (LC-MS/MS). Maximum measured plasma MPA concentrations were 6.06 ± 1.57 at 0.271 days (6.5 h; range: 5.0-7.92 h) and 6.27 ± 1.29 ng/mL at 0.276 days (6.6 h; range: 4.03-12.0 h) for horses that had synovial fluid collected (group 1) and those that did not (group 2), respectively. The plasma terminal half-life was 1.33 ± 0.80 and 0.843 ± 0.414 days for groups 1 and 2, respectively. MPA was undetectable by day 6.25 ± 2.12 (group 1) and 4.81 ± 2.56 (group 2) in plasma and day 17 (group 1) and 14 (group 2) in urine. MPA concentrations in synovial fluid remained above the limit of detection (LOD) for up to 77 days following intra-articular administration, suggesting that plasma and urine concentrations are not a good indicator of synovial fluid concentrations. © 2013 John Wiley & Sons Ltd.

  13. Estudo de lidocaína a 0,5% e combinação de lidocaína a 0,25% com fentanil e vecurônio em anestesia regional intravenosa para cirurgias de membros superiores Estudio de la lidocaína al 0,5% y en combinación de lidocaína al 0,25% con fentanilo y vecuronio en anestesia regional intravenosa para cirugías de miembros superiores Study of 0.5% lidocaine alone and combination of 0.25% lidocaine with fentanyl and vecuronium in intravenous regional anesthesia for upper limb surgeries

    Directory of Open Access Journals (Sweden)

    Santhosh MCB

    2013-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A anestesia regional intravenosa (ARIV para cirurgias de membros superiores com a tradicional alta dose de lidocaína pode levar a efeitos colaterais potencialmente letais. A fim de evitar esses efeitos, muitas técnicas modificadas de ARIV foram experimentadas com o uso de uma dose baixa de lidocaína, relaxante muscular e opioide. MÉTODOS: O presente estudo foi feito com 60 pacientes não medicados previamente, com classificação ASA 1-2, para comparar as características sensoriais e motoras, os parâmetros cardiorrespiratórios e os efeitos colaterais durante o período intraoperatório e de deflação pós-torniquete entre os pacientes que receberam 40 mL de lidocaína a 0,5% (n = 30 e aqueles que receberam uma combinação de 40 mL de lidocaína a 0,25% com 0,05 mg de fentanil e 0,5 mg de vecurônio (n = 30 em ARIV para cirurgias ortopédicas de membros superiores. Os resultados foram analisados com o uso do teste t de Student pareado para identificar a significância estatística. RESULTADO: A diferença entre os dois grupos em relação ao tempo médio de início e completo bloqueio sensitivo e motor foi estatisticamente significante. Porém, houve completo bloqueio sensitivo e motor em ambos os grupos 15 minutos após a injeção da solução anestésica. CONCLUSÃO: Embora a pequena demora observada no início e na obtenção completa dos bloqueios sensitivo e motor possa, teoricamente, atrasar o início da cirurgia em 10-15 minutos, clinicamente esse tempo seria gasto na preparação do campo cirúrgico. Portanto, essa combinação pode ser usada com segurança e eficácia em anestesia regional intravenosa para cirurgias ortopédicas de membros superiores com menor possibilidade de toxicidade anestésica local.JUSTIFICATIVA Y OBJETIVOS: La anestesia regional intravenosa (ARIV para cirugías de miembros superiores con la tradicional dosis alta de lidocaína, puede conllevar a efectos colaterales que

  14. Temperatura, Oximetría Cerebral y Disfunción Cognitiva Postoperatoria (DCPO) en pacientes intervenidos de Prótesis Total de Rodilla (PTR) con anestesia intradural. Estudio prospectivo

    OpenAIRE

    Salazar Garcia, Fátima

    2015-01-01

    Introducción: La Disfunción cognitiva postoperatoria (DCPO) tiene una alta incidencia en pacientes de cirugía ortopédica. Durante la anestesia y la cirugía se produce un descenso progresivo de la temperatura. Esta hipotermia tiene efectos deletéreos pero también puede tener un efecto protector cerebral. Nosotros planteamos la hipótesis que la temperatura perioperatoria puede tener un impacto sobre la aparición de DCPO. Por otro lado, la monitorización de la saturación regional cerebral de...

  15. Intraarticular injections (corticosteroid, hyaluronic acid, platelet rich plasma) for the knee osteoarthritis

    Science.gov (United States)

    Ayhan, Egemen; Kesmezacar, Hayrettin; Akgun, Isik

    2014-01-01

    Osteoarthritis (OA) is a complex “whole joint” disease pursued by inflammatory mediators, rather than purely a process of “wear and tear”. Besides cartilage degradation, synovitis, subchondral bone remodeling, degeneration of ligaments and menisci, and hypertrophy of the joint capsule take parts in the pathogenesis. Pain is the hallmark symptom of OA, but the extent to which structural pathology in OA contributes to the pain experience is still not well known. For the knee OA, intraarticular (IA) injection (corticosteroids, viscosupplements, blood-derived products) is preferred as the last nonoperative modality, if the other conservative treatment modalities are ineffective. IA corticosteroid injections provide short term reduction in OA pain and can be considered as an adjunct to core treatment for the relief of moderate to severe pain in people with OA. IA hyaluronic acid (HA) injections might have efficacy and might provide pain reduction in mild OA of knee up to 24 wk. But for HA injections, the cost-effectiveness is an important concern that patients must be informed about the efficacy of these preparations. Although more high-quality evidence is needed, recent studies indicate that IA platelet rich plasma injections are promising for relieving pain, improving knee function and quality of life, especially in younger patients, and in mild OA cases. The current literature and our experience indicate that IA injections are safe and have positive effects for patient satisfaction. But, there is no data that any of the IA injections will cause osteophytes to regress or cartilage and meniscus to regenerate in patients with substantial and irreversible bone and cartilage damage. PMID:25035839

  16. Functional outcome of intra-articular tibial plateau fractures: the impact of posterior column fractures.

    Science.gov (United States)

    van den Berg, Juriaan; Reul, Maike; Nunes Cardozo, Menno; Starovoyt, Anastasiya; Geusens, Eric; Nijs, Stefaan; Hoekstra, Harm

    2017-09-01

    INTRODUCTION: Although regularly ignored, there is growing evidence that posterior tibial plateau fractures affect the functional outcome. The goal of this study was to assess the incidence of posterior column fractures and its impact on functional outcome and general health status. We aimed to identify all clinical variables that influence the outcome and improve insights in the treatment strategies. A retrospective cohort study including 218 intra-articular tibial plateau fractures was conducted. All fractures were reclassified and applied treatment was assessed according to the updated three-column concept. Relevant demographic and clinical variables were studied. The patient reported outcome was assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS). Median follow-up was 45.5 (IQR 24.9-66.2) months. Significant outcome differences between operatively and non-operatively treated patients were found for all KOOS subscales. The incidence of posterior column fractures was 61.9%. Posterior column fractures, sagittal malalignment and an increased complication rate were associated with poor outcome. Patients treated according to the updated three-column concept, showed significantly better outcome scores than those patients who were not. We could not demonstrate the advantage of posterior column fracture fixation, due to a limited patient size. Our data indicates that implementation of the updated three-column classification concept may improve the surgical outcome of tibial plateau fractures. Failure to recognize posterior column fractures may lead to inappropriate utilization of treatment techniques. The current concept allows us to further substantiate the importance of reduction and fixation of posterior column fractures with restoration of the sagittal alignment. 3.

  17. Prognostic value of computed tomography classification systems for intra-articular calcaneus fractures.

    Science.gov (United States)

    Swords, Michael P; Alton, Timothy B; Holt, Sarah; Sangeorzan, Bruce J; Shank, John R; Benirschke, Stephen K

    2014-10-01

    There are several published computed tomography (CT) classification systems for calcaneus fractures, each validated by a different standard. The goal of this study was to measure which system would best predict clinical outcomes as measured by a widely used and validated musculoskeletal health status questionnaire. Forty-nine patients with isolated intra-articular joint depression calcaneus fractures more than 2 years after treatment were identified. All had preoperative CT studies and were treated with open reduction and plate fixation using a lateral extensile approach. Four different blinded reviewers classified injuries according to the CT classification systems of Crosby and Fitzgibbons, Eastwood, and Sanders. Functional outcomes evaluated with a Musculoskeletal Functional Assessment (MFA). The mean follow-up was 4.3 years. The mean MFA score was 15.7 (SD = 11.6), which is not significantly different from published values for midfoot injuries, hindfoot injuries, or both, 1 year after injury (mean = 22.1, SD = 18.4). The classification systems of Crosby and Fitzgibbons, Eastwood, and Sanders, the number of fragments of the posterior facet, and payer status were not significantly associated with outcome as determined by the MFA. The Sanders classification trended toward significance. Anterior process comminution and surgeon's overall impression of severity were significantly associated with functional outcome. The amount of anterior process comminution was an important determinant of functional outcome with increasing anterior process comminution significantly associated with worsened functional outcome (P = .04). In addition, the surgeon's overall impression of severity of injury was predictive of functional outcome (P = .02), as determined by MFA. Level III, comparative series. © The Author(s) 2014.

  18. Intra-articular injection in patients with juvenile idiopathic arthritis: factors associated with a good response

    Directory of Open Access Journals (Sweden)

    Ana Luiza Garcia Cunha

    Full Text Available ABSTRACT Introduction: Intra-articular injection of corticosteroids (IIC for treatment of patients with juvenile idiopathic arthritis (JIA is increasingly used in Pediatric Rheumatology. Objectives: To describe the clinical course of patients undergoing IIC in our Pediatric Rheumatology Unit. Methods: Retrospective study of patients with JIA undergoing IIC from January 2008 to December 2012, with a minimum follow-up of six months after the injection. Good response to IIC was set as the presence of inactivity on the infiltrated joint by at least six months. Results: Eighty-eight patients underwent a total of 165 IICs. Of these, 75% were girls and 35.2% had persistent oligoarticular JIA. The mean age at diagnosis was 6.8 years, and when IIC was carried out, 12.2 years. Regarding patients, younger age at diagnosis (p = 0.037 and the occurrence of uveitis in the course of the disease (p = 0.015 were associated with good response to IIC. From 165 IICs, 63% had a good response and joints remained inactive for a median of 18.1 months. The type of joint injection (p = 0.001, lesser values stated in the overall visual analog scale by the physician (p = 0.015 and by parents/patient (p = 0.01 have been associated with a good response to IIC. Nine adverse events (5.4% were observed. Conclusion: In our study, more than half of the joints showed a good response to IIC. Younger patients at diagnosis and uveitis during the course of the disease had good response to IIC. Knees, wrists and elbows were the joints that best responded to IIC. IIC proved to be a safe procedure.

  19. In vitro evaluation and intra-articular administration of biodegradable microspheres containing naproxen sodium.

    Science.gov (United States)

    Bozdağ, S; Caliş, S; Kaş, H S; Ercan, M T; Peksoy, I; Hincal, A A

    2001-01-01

    The dispersion of non-steroidal antiinflammatory drugs (NSAIDs) into biodegradable polymeric matrices have been accepted as a good approach for obtaining a therapeutic effect in a predetermined period of time meanwhile minimizing the side effects of NSAIDs. In the present study, it was aimed to prepare Naproxen Sodium (NS), (a NSAID) loaded microsphere formulation using natural Bovine Serum Albumin (BSA) and synthetic biodegradable polymers such as poly(lactide-co-glycolic acid) (PLGA) (50:50 MW 34,000 and 88,000 Da) for intra-articular administration, and to study the retention of the drug at the site of injection in the knee joint. NS incorporated microspheres were evaluated in vitro for particle size (the mean particle size; for BSA microspheres, 10.0 +/- 0.3 microm, for PLGA microspheres, 9.0 +/- 0.2 and 5.0 +/- 0.1 microm for MW 34,000 and 88,000 Da, respectively), yield value, drug loading, surface morphology and drug release. For in vivo studies, monoarticular arthritis was induced in the left knee joints of rabbits by using ovalbumin and Freund's Complete Adjuvant as antigen and adjuvant. A certain time (4 days) is allowed for the formation of arthritis in the knee joints, then the NS loaded microspheres were injected directly into the articular cavity. At specific time points, gamma scintigrams were obtained to determine the residence time of the microspheres in knee joints, in order to determine the most suitable formulation. This study indicated that PLGA, a synthetic polymer, is more promising than the natural type BSA microspheres for an effective cure of mono-articular arthritis in rabbits.

  20. Effectiveness of imaging-guided intra-articular injection: a comparison study between fluoroscopy and ultrasound.

    Science.gov (United States)

    Furtado, Rita Nely Vilar; Pereira, Daniele Freitas; da Luz, Karine Rodrigues; dos Santos, Marla Francisca; Konai, Monique Sayuri; Mitraud, Sonia de Aguiar Vilela; Rosenfeld, Andre; Fernandes, Artur da Rocha Correa; Natour, Jamil

    2013-01-01

    Compare the effectiveness of ultrasound and fluoroscopy to guide intra-articular injections (IAI) in selected cases. A prospective study in our outpatient clinics at the Rheumatology Division at Universidade Federal de São Paulo (UNIFESP), Brazil, was conducted to compare the short-term (4 weeks) effectiveness of ultrasound and fluoroscopy-guided IAI in patients with rheumatic diseases. Inclusion criteria were: adults with refractory synovitis undergoing IAI with glucocorticoid. All patients had IAI performed with triamcinolone hexacetonide (20mg/ml) with varying doses according to the joint injected. A total of 71 rheumatic patients were evaluated (52 women, 44 whites). Mean age was 51.9 ± 13 years and 47 of them (66.2%) were on regular DMARD use. Analysis of the whole sample (71 patients) and hip sub-analysis (23 patients) showed that significant improvement was observed for both groups in terms of pain (P < 0.001). Global analysis also demonstrated better outcomes for patients in the FCG in terms of joint flexion (P < 0.001) and percentage change in joint flexion as compared to the USG. Likert scale score analyses demonstrated better results for the patients in the USG as compared to the FCG at the end of the study (P < 0.05). No statistically significant difference between groups was observed for any other study variable. Imaging-guided IAI improves regional pain in patients with various types of synovitis in the short term. For the vast majority of variables, no significant difference in terms of effectiveness was observed between fluoroscopy and ultrasound guided IAI.

  1. Combined Volar and Dorsal Approach for Fixation of Comminuted Intra-Articular Distal Radial Fractures.

    Science.gov (United States)

    Medlock, G; Smith, M; Johnstone, A J

    2018-07-01

    Purpose  Multifragmentary intra-articular fractures displaced in multiple planes are a challenge. We use a reproducible technique of fracture and articular reduction using an initial volar approach targeting reduction in the volar lunate facet first with plate and unicortical locking screws. This creates a template for reduction in dorsal fragments through a dorsal approach. Our study investigated the radiological, clinical, and functional outcomes of patients treated with this technique. Materials and Methods  We reviewed the postoperative radiographs and notes of 18 patients that had this method of fixation between the years 2008 and 2015, the mean age being 43. These patients were reviewed functionally on average 2 years and 3 months following their definitive operation. Results  Normal alignment and length to the distal radius were restored with on average a 0.6 mm articular step. The average range of motion was 64% and preservation of grip strength was 71% compared with the uninjured wrist. Functional assessment averages were 29 for both the quick Disabilities of the Arm, Shoulder and Hand (DASH) and for Patient Rated Wrist Evaluation. The modified system of Green and O'Brien had results of good in 10, fair in 7, and poor in 1. With respect to the Gartland and Werley system, three patients had an excellent result, four had a good result, six had a fair result, and five had a poor result. The mean arthritic grading was 1 (grading 0-3) according to Knirk and Jupiter. Conclusion  This reproducible technique provides an option for these devastating fractures providing a functioning wrist with all of the patients returning to their original form of employment.

  2. Epidural anesthesia using a 0,75% ropivacaine and subarachnoid anesthesia with a 0,5% bupivacaine associated or not with clonidine in hemorroidectomies Anestesia peridural com ropivacaína a 0,75% e anestesia subaracnóidea com bupivacaína a 0,5% associadas ou não à clonidina em hemorroidectomias

    Directory of Open Access Journals (Sweden)

    João Florêncio de Abreu Baptista

    2008-12-01

    24 horas foram anotados. RESULTADOS: A intensidade da dor, 8 horas após a cirurgia, foi menor no grupo 4, e significantemente menor no grupo 4 em relação aos grupos 1 e 2, 12 horas (p=0,022; p=0,001 e 24 horas (p=0,03; p=0,003. A freqüência do uso de vasoconstritores no transoperatório e de analgésicos no pós-operatório não diferiu entre os grupos. Não houve complicações anestésicas. CONCLUSÕES: A anestesia subaracnóidea com bupivacaína a 0,5%, com clonidina, apresentou melhor analgesia que a anestesia peridural com ropivacaína a 0,75% com ou sem clonidina, porém todas foram seguras e eficazes. A clonidina contribuiu para diminuir a dor na anestesia subracnóidea.

  3. Advantages of the Ilizarov external fixation in the management of intra-articular fractures of the distal tibia

    Directory of Open Access Journals (Sweden)

    Kaspiris Angelos

    2009-09-01

    Full Text Available Abstract Background Treatment of distal tibial intra-articular fractures is challenging due to the difficulties in achieving anatomical reduction of the articular surface and the instability which may occur due to ligamentous and soft tissue injury. The purpose of this study is to present an algorithm in the application of external fixation in the management of intra-articular fractures of the distal tibia either from axial compression or from torsional forces. Materials and methods Thirty two patients with intra-articular fractures of the distal tibia have been studied. Based on the mechanism of injury they were divided into two groups. Group I includes 17 fractures due to axial compression and group II 15 fractures due to torsional force. An Ilizarov external fixation was used in 15 patients (11 of group I and 4 of group II. In 17 cases (6 of group I and 11 of group II a unilateral hinged external fixator was used. In 7 out of 17 fractures of group I an additional fixation of the fibula was performed. Results All fractures were healed. The mean time of removal of the external fixator was 11 weeks for group I and 10 weeks for group II. In group I, 5 patients had radiological osteoarthritic lesions (grade III and IV but only 2 were symptomatic. Delayed union occurred in 3 patients of group I with fixed fibula. Other complications included one patient of group II with subluxation of the ankle joint after removal of the hinged external fixator, in 2 patients reduction found to be insufficient during the postoperative follow up and were revised and 6 patients had a residual pain. The range of ankle joint motion was larger in group II. Conclusion Intra-articular fractures of the distal tibia due to axial compression are usually complicated with cartilaginous problems and are requiring anatomical reduction of the articular surface. Fractures due to torsional forces are complicated with ankle instability and reduction should be augmented with ligament

  4. A new building block: costo-osteochondral graft for intra-articular incongruity after distal radius fracture.

    Science.gov (United States)

    Tang, Chris Yuk Kwan; Fung, Boris; Poon, T L; Fok, Margaret

    2014-01-01

    Even with the invention of locking plates, intra-articular fractures of distal radius with extreme comminution remain a challenge for orthopaedic surgeons. Osteochondral graft is a potential choice to reconstruct the articular defect. We report a patient who had a fracture of distal radius with costo-osteochondral graft for articular reconstruction which has not yet been described in the English literature. At nine-year follow-up, he was pain free and had full range of movement of the wrist. The authors suggest that costo-osteochondral graft could be an option with satisfactory result.

  5. Advantages of the Ilizarov external fixation in the management of intra-articular fractures of the distal tibia

    Science.gov (United States)

    Vasiliadis, Elias S; Grivas, Theodoros B; Psarakis, Spyridon A; Papavasileiou, Evangelos; Kaspiris, Angelos; Triantafyllopoulos, Georgios

    2009-01-01

    Background Treatment of distal tibial intra-articular fractures is challenging due to the difficulties in achieving anatomical reduction of the articular surface and the instability which may occur due to ligamentous and soft tissue injury. The purpose of this study is to present an algorithm in the application of external fixation in the management of intra-articular fractures of the distal tibia either from axial compression or from torsional forces. Materials and methods Thirty two patients with intra-articular fractures of the distal tibia have been studied. Based on the mechanism of injury they were divided into two groups. Group I includes 17 fractures due to axial compression and group II 15 fractures due to torsional force. An Ilizarov external fixation was used in 15 patients (11 of group I and 4 of group II). In 17 cases (6 of group I and 11 of group II) a unilateral hinged external fixator was used. In 7 out of 17 fractures of group I an additional fixation of the fibula was performed. Results All fractures were healed. The mean time of removal of the external fixator was 11 weeks for group I and 10 weeks for group II. In group I, 5 patients had radiological osteoarthritic lesions (grade III and IV) but only 2 were symptomatic. Delayed union occurred in 3 patients of group I with fixed fibula. Other complications included one patient of group II with subluxation of the ankle joint after removal of the hinged external fixator, in 2 patients reduction found to be insufficient during the postoperative follow up and were revised and 6 patients had a residual pain. The range of ankle joint motion was larger in group II. Conclusion Intra-articular fractures of the distal tibia due to axial compression are usually complicated with cartilaginous problems and are requiring anatomical reduction of the articular surface. Fractures due to torsional forces are complicated with ankle instability and reduction should be augmented with ligament repair, in order to

  6. Intra-articular distribution pattern after ultrasound-guided injections in wrist joints of patients with rheumatoid arthritis

    DEFF Research Database (Denmark)

    Boesen, Mikael; Jensen, Karl Erik; Torp-Pedersen, Søren

    2007-01-01

    OBJECTIVE: To investigate the distribution of an ultrasound-guided intra-articular (IA) injection in the wrist joint of patients with rheumatoid arthritis (RA). METHODS: An ultrasound-guided IA drug injection into the wrist joint was performed in 17 patients with 1 ml methylprednisolone (40 mg...... with the MRI OMERACT synovitis score (r=0.60, p=0.014), but not with the erosions, bonemarrow oedema scores or any clinical parameters. CONCLUSION: The distribution of contrast on MRI showed patient specific and random patterns after IA injections in active RA wrist joints. The degree of distribution increased...

  7. Anestesia venosa total para laringectomia parcial em paciente na 28ª semana de gestação: relato de caso Anestesia venosa total para laringectomía parcial en paciente en la 28ª semana de embarazo: relato de caso Total intravenous anesthesia for partial laryngectomy in 28 weeks pregnant patient: case report

    Directory of Open Access Journals (Sweden)

    José Costa

    2005-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Uma anestesia para paciente gestante constitui um desafio ao anestesiologista em virtude dos riscos para a mãe e para o feto. São muitas as complicações descritas pela literatura como malformações fetais, parto prematuro, instabilidade hemodinâmica materna e até morte fetal. O objetivo deste caso é mostrar uma paciente gestante de 28 semanas, submetida a laringectomia parcial sob anestesia geral venosa total com propofol, remifentanil e cisatracúrio. RELATO DO CASO: Paciente com 29 anos, 59 kg, primigesta de 28 semanas com diagnóstico prévio de carcinoma epidermóide próximo à corda vocal direita, sendo indicada laringectomia. A monitorização inicial constituiu-se de pressão arterial não-invasiva e invasiva, cardioscopia, oxicapnografia e cardiotocografia contínua realizada pela obstetra. Punção venosa no membro superior direito e membro superior esquerdo com cateter 16G e 18G, respectivamente. Foram administrados por via venosa midazolam (1 mg, cefazolina (1 g, metoclopramida (10 mg e dipirona (1 g. A paciente recebeu oxigênio a 100% sob máscara por 3 minutos e indução venosa foi feita com o uso de propofol em infusão na dose alvo de 3 µg.mL-1 e remifentanil contínuo (1 µg.kg-1 em bolus e 0,2 µg.kg-1.min-1 de manutenção. Como bloqueador neuromuscular, foi administrado cisatracúrio (13 mg e procedeu-se a intubação traqueal com tubo 6,5 mm aramado com balonete. Foi mantida em plano anestésico com propofol e remifentanil em bomba, além de complementações de cisatracúrio. O feto permaneceu monitorizado continuamente com cardiotocografia realizada e analisada pela obstetra. Após o término da cirurgia foram desligadas as bombas infusoras de propofol e remifentanil, tendo a paciente despertado 10 minutos depois. Acordou sem dor e hemodinamicamente estável, sendo então encaminhada à sala de recuperação pós-anestésica. CONCLUSÕES: A anestesia venosa total com propofol e

  8. Anestesia em anã acondroplásica obesa mórbida para gastroplastia redutora Anestesia en enana acondroplásica obesa mórbida para gastroplastia reductora Anesthesia for bariatric surgery in an achondroplastic dwarf with morbid obesity

    Directory of Open Access Journals (Sweden)

    Maria Angélica Abrão

    2009-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A acondroplasia é a forma mais comum entre os diversos tipos de osteocondrodisplasias causadoras do nanismo. O anão pode ser acometido de obesidade com relativa frequência e o tratamento cirúrgico tem demonstrado maior eficácia tanto para a perda efetiva de peso quanto para a sua manutenção a longo prazo. O objetivo deste trabalho foi apresentar um caso de gastroplastia redutora com derivação intestinal em Y-de-Roux em anão acondroplásico obeso mórbido. Foram analisadas as diversas dificuldades encontradas no manuseio anestésico deste paciente e a maneira pela qual foram abordadas, objetivando a diminuição da morbimortalidade no intra-operatório. RELATO DO CASO: Paciente de 29 anos, feminina, anã com acondroplasia e obesidade mórbida desde a infância. Suas medidas eram de 123 cm de altura e peso corporal de 144 kg. Com índice de massa corporal (IMC de 95,18 kg.m-2, apresentava várias doenças associadas, sobretudo dos sistemas respiratório e osteoarticular. Após longo período de acompanhamento com dieta, exercícios físicos e apoio psicológico, a paciente melhorou sua condição clínica, sendo encaminhada para a realização da operação proposta: gastroplastia redutora à Capella-Fobi. Na anestesia houve dificuldade na intubação traqueal acordada sob laringoscopia direta, sendo necessária a utilização do broncofibroscópio. Transcurso intra-operatório sem complicações, sendo mantida sob anestesia geral venosa total com infusão contínua de remifentanil e propofol. Extubada ao final do procedimento na sala cirúrgica. CONCLUSÕES: As comorbidades simultâneas da acondroplasia e da obesidade mórbida podem dificultar o manuseio anestésico, sobretudo em relação às vias aéreas. É necessário uma avaliação pré-anestésica bem conduzida para antecipar condutas e minimizar esses riscos, otimizando, assim, a condução da anestesia.JUSTIFICATIVA Y OBJETIVOS: La acondroplasia es la

  9. Anestesia venosa total (AVT em lactente com doença de Werdnig-Hoffmann: relato de caso Anestesia general intravenosa (AVT en lactante con enfermedad de Werdnig-Hoffmann: relato de caso Total intravenous anesthesia (TIVA in an infant with Werdnig-Hoffmann disease: case report

    Directory of Open Access Journals (Sweden)

    Marco Antonio Cardoso de Resende

    2010-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A doença de Werdnig-Hoffmann é a causa mais comum de hipotonia no lactente e quando presente logo após o nascimento tem pior prognóstico. Fraqueza muscular simétrica, arreflexia e fasciculações da língua são característicos. A maioria dos lactentes morre antes dos dois anos por insuficiência respiratória. O presente relato apresenta um caso com técnica venosa total durante anestesia. RELATO DO CASO: Paciente feminina, branca, um ano, 10 kg, estado físico ASA III, com doença de Werdnig-Hoffmann diagnosticada desde os dois meses de idade. Candidata à gastrostomia e fundogastroplicatura na técnica aberta e traqueostomia. Monitorização com cardioscópio, pressão arterial não invasiva, oxímetro de pulso, estetoscópio precordial e temperatura retal após venóclise. Foi préoxigenada e após bolus de atropina (0,3 mg foi realizada indução anestésica com remifentanil bolus (20 µg e propofol (30 mg. Após intubação traqueal foi ventilada de forma controlada manual, em sistema sem absorvedor de CO2, Baraka (sistema Mapleson D, FGF de 4 L.min-1, FiO2 0,5 (0(2/N(20. Mantida sob anestesia com propofol 250 µg.kg-1.min-1 e remifentanil 0,3 µg.kg-1.min-1 em infusão contínua manual. O tempo cirúrgico foi de 150 minutos. O despertar ocorreu 8 minutos após o término da infusão, com ventilação espontânea. Duas horas depois foi transferida para unidade pediátrica e recebeu alta hospitalar no 4º dia de pós-operatório. CONCLUSÕES: A escolha da técnica anestésica prioriza a segurança que advém da familiaridade do manuseio dos fármacos existentes. Em crianças com doenças neuromusculares, a anestesia venosa total com remifentanil e propofol em sistemas de infusão, pela duração de ação extremamente curta, pode influenciar a evolução da doença favoravelmente.JUSTIFICATIVA Y OBJETIVOS: La enfermedad de Werdnig-Hoffmann es la causa más común de hipotonía en el lactante y cuando est

  10. Complicações respiratórias em pacientes com paralisia cerebral submetidos à anestesia geral Complicaciones respiratorias en pacientes con parálisis cerebral sometidos a la anestesia general Respiratory complications in patients with cerebral palsy undergoing general anesthesia

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    Sérgio Silva de Mello

    2007-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Anestesia em pacientes com paralisia cerebral (PC pode representar um desafio para o anestesiologista. Este estudo prospectivo teve como objetivo determinar a prevalência e o risco de complicações respiratórias em crianças com PC submetidas à anestesia geral inalatória (AGI para tomografia computadorizada (TC. MÉTODO: Participaram do estudo pacientes com idades entre 1 e 17 anos, estado físico ASA I a III, submetidos a AGI com sevoflurano e máscara laríngea para TC no período de junho/2002 a junho/2003, divididos em três grupos: PC tetraplégicos (PCT, outros tipos de PC (PCO e paciente sem PC (NPC. Os pais ou responsáveis responderam a um questionário com perguntas sobre o histórico médico dos pacientes, infecção de vias aéreas superiores (IVAS, asma, convulsão, incoordenação orofaríngea, refluxo gastroesofágico, etc. Dados sobre incidência e gravidade das complicações respiratórias foram coletados prospectivamente (tosse, broncoespasmo, laringoespasmo, hipoxemia, aspiração. A amostra foi calculada para uma incidência esperada de 5% no grupo NPC, com uma diferença de 15% entre os grupos (alfa = 0,05 e beta = 0,1, utilizando-se os testes do Qui-quadrado, exato de Fisher e t de Student. RESULTADOS: Compuseram a amostra 290 pacientes divididos nos grupos da seguinte forma: PCT - 100, PCO - 79 e NPC - 111. Não houve diferença na prevalência de complicações respiratórias entre os grupos PCT (4%, PCO (8,9% e NPC (7,3%. Houve associação entre a presença de IVAS e a ocorrência de complicações (risco relativo, 10,71. CONCLUSÕES: Crianças com paralisia cerebral tipo tetraplegia espástica não parecem ter um risco aumentado de complicações respiratórias durante anestesia geral inalatória com sevoflurano e máscara laríngea. O estudo confirma IVAS como fator de risco para a ocorrência dessas complicações.JUSTIFICATIVA Y OBJETIVOS: La anestesia en pacientes con par

  11. Anestesia para cesariana em paciente portadora de cardiomiopatia hipertrófica familiar: relato de caso Anestesia para cesária en paciente portadora de cardiomiopatía hipertrófica familiar: relato de caso Anesthesia for cesarean section in a patient with familiar hypertrophic cardiomyopathy: case report

    Directory of Open Access Journals (Sweden)

    Renato Mestriner Stocche

    2007-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A cardiomiopatia hipertrófica familiar (CHF é uma doença cardíaca rara, com transmissão hereditária, caracterizada por hipertrofia do septo ventricular e grau variável de estenose aórtica subvalvar. Nessa doença, o aumento da contratilidade do miocárdio e a diminuição da resistência vascular periférica podem agravar a obstrução da via de saída do VE, produzindo disritmia e isquemia cardíaca. Este relato objetivou discutir o manuseio anestésico para cesariana em paciente com CHF. RELATO DO CASO: Paciente com 33 semanas de gestação e diagnóstico prévio de CHF apresentou no holter de 24 horas 22 episódios de taquicardia ventricular não-sustentada (TVNS e dois episódios de taquicardia ventricular sustentada (TVS. Referia episódios de palpitação, dispnéia e dor precordial de curta duração. A paciente foi medicada com atenolol e apresentou controle dos sintomas e das disritmias cardíacas. Com 38 semanas e 5 dias de gestação a paciente foi submetida à cesariana eletiva. Além do habitual a monitorização contou com análise de segmento ST e pressão arterial invasiva. Utilizou-se anestesia raquiperidural com injeção de 5 µg de sunfentanil na raqui seguida de administração de bupivacaína a 0,375% em doses de incremento até atingir altura de T6 (total de 16 mL. Utilizou-se metaraminol como vasopressor. Não houve hipotensão arterial materna ou outras complicações no perioperatório. CONCLUSÕES: A anestesia geral é freqüentemente utilizada para cesarianas de pacientes com CHF. A anestesia raquiperidural com instalação lenta do bloqueio foi uma alternativa segura. Nessas pacientes, o aumento da contratilidade miocárdica deve ser evitado, devendo-se, se necessário, utilizar-se um a-agonista para correção de hipotensão arterial materna.JUSTIFICATIVA Y OBJETIVOS: La cardiomiopatía hipertrófica familiar (CHF es una enfermedad cardiaca rara con transmisión hereditaria

  12. Combination Intravenous and Intra-Articular Tranexamic acid compared with Intravenous Only Administration and No Therapy in Total Knee Arthroplasty: A Case Series Study

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    Chris Buntting

    2016-07-01

    This study supports the existing literature and suggests that the use of IV Tranexamic acid alone or in combination with intra-articular dose in TKA may reduce the requirement for transfusion (Level IV evidence. Furthermore, this study suggests that the use of tranexamic acid as a combination of Intravenous and intra-articular administration has no effect on range of motion, or medical complications during hospital stay. Although it was not a statistically significant finding, our study suggested a trend towards a greater reduction in haemoglobin and haematocrit fall in the combination therapy group when compared to IV Tranexamic acid alone

  13. Análise da sintomatologia em pacientes com disfunções intra-articulares da articulação temporomandibular Analysis of symptomatology in patients with intra-articular disorders of the temporomandibular joint

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    Sílvio Henrique de Paula DONEGÁ

    1997-01-01

    Full Text Available Foi realizado estudo analisando a sintomatologia em pacientes com disfunções intra-articulares da articulação temporomandibular. A queixa mais citada foi de dor na região pré-auricular (40,7%. Sintomatologia dolorosa articular (63,2% e ruídos articulares (83,3% foram os achados mais comuns ao exame clínico. Os ruídos articulares mais freqüentes foram os estalos (66,6%. Dor muscular ocorreu, em especial, nos músculos pterigóideo medial e lateral e na inserção do temporal. Houve decréscimo na amplitude para a protrusão dentre os movimentos mandibulares máximosThe study analyzed the symptomatology in patients with intra-articular disorders of the temporomandibular joint. The most frequent complaint was pain in the preauricular region (40.7%. Articular pain (63.2% and articular sounds (83.3% were the most common findings during clinical examination. Muscular pain occurred particularly in the medial and lateral pterygoid muscles and at the insertion of the temporalis muscle. The most frequent articular sound was clicking (66.6%. There was a decrease in extent of protrusion among the mandibular border positions.

  14. MANAGEMENT OF PRIMARY FROZEN SHOULDER PROSPECTIVE EVALUATION OF FUNCTIONAL OUTCOME BETWEEN HYDRODILATATION AND INTRA-ARTICULAR STEROID INJECTION

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    Dinesh Mitra R. P

    2017-01-01

    Full Text Available BACKGROUND The aim of this prospective randomized control study is to compare the functional outcome between hydrodilatation and intraarticular steroid injection in patients with primary frozen shoulder. MATERIALS AND METHODS A total number of 52 patients who attended the orthopaedic outpatient between November 2014 and January 2016 were included in this study. The patients were categorized into two groups. Group I patients were treated with hydrodilatation method and Group II patients were treated with intra-articular steroids. Both the group of patients were advised to perform home exercise programs. The patients were assessed at baseline (before the procedure at two weeks, six weeks, three months and six months. All patients were evaluated for functional improvement by measuring the range of active movements and Constant and Murley shoulder outcome scores. RESULTS Up to three months patients treated with hydrodilatation have significantly better functional outcome as evaluated by active range of movements and Constant and Murley score. But at six months there is no significant difference in functional outcome between two methods of treatment. CONCLUSION There was improvement in functional outcome in both the methods of treatment. But patients treated by hydrodilatation showed more significant increase in functional outcome for the first three months. Home exercise forms an integral part in the management of primary frozen shoulder.

  15. Intra-Articular Hyaluronic Acid Compared to Traditional Conservative Treatment in Dogs with Osteoarthritis Associated with Hip Dysplasia

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    Gabriel O. L. Carapeba

    2016-01-01

    Full Text Available The purpose of this study was to compare the efficacy of the intra-articular (IA hyaluronic acid injection to traditional conservative treatment (TCT in dogs with osteoarthritis (OA induced by hip dysplasia. Sixteen dogs were distributed into two groups: Hyal: IA injection of hyaluronic acid (5–10 mg, and Control: IA injection with saline solution (0.5–1.0 mL in combination with a TCT using an oral nutraceutical (750–1000 mg every 12 h for 90 days and carprofen (2.2 mg/kg every 12 h for 15 days. All dogs were assessed by a veterinarian on five occasions and the owner completed an assessment form (HCPI and CPBI at the same time. The data were analyzed using unpaired t test, ANOVA, and Tukey’s test (P<0.05. Compared with baseline, lower scores were observed in both groups over the 90 days in the veterinarian evaluation, HCPI, and CPBI (P<0.001. The Hyal group exhibited lower scores from 15 to 90 and 60 to 90 days, in the CBPI and in the veterinarian evaluation, respectively, compared to the Control group. Both treatments reduced the clinical signs associated with hip OA. However, more significant results were achieved with intra-articular hyaluronic acid injection.

  16. Synovial response to intraarticular injections of hyaluronate in frozen shoulder. A quantitative assessment with dynamic magnetic resonance imaging

    International Nuclear Information System (INIS)

    Tamai, Kazuya; Mashitori, Hirotaka; Ohno, Wataru; Hamada, Jun'ichiro; Sakai, Hiroya; Saotome, Koichi

    2004-01-01

    To clarify the response of frozen shoulder (FS) to intraarticular injections of high-molecular-weight sodium hyaluronate (HA), a mixture of 2.5 ml of HA and 1.5 ml of 1% lidocaine was injected into the glenohumeral joint of 11 patients with FS, 8 of whom received five weekly injections. The patients were assessed using the Japanese Orthopaedic Association shoulder score (JOA score) before the first injection, 1 week after the first injection, and 1 week after the final injection. Following each clinical evaluation, the patients underwent dynamic magnetic resonance imaging enhanced with Gd-DTPA, and the coefficient of enhancement (CE) in the glenohumeral synovium was calculated, with the examiners blinded to the clinical information. The JOA score tended to be greater and the CE smaller after injection than before injection. The changes in the CE following both single and repeated injections were negatively correlated with changes in the JOA score. Thus, clinical improvement in patients with FS was associated with a decrease in the CE. Because the CE depends on the degree of synovitis, the therapeutic effect of intraarticular HA injection for FS results, at least in part, from suppression of synovitis in the glenohumeral joint through an antiinflammatory effect. (author)

  17. Choice of intra-articular injection in treatment of knee osteoarthritis: platelet-rich plasma, hyaluronic acid or ozone options.

    Science.gov (United States)

    Duymus, Tahir Mutlu; Mutlu, Serhat; Dernek, Bahar; Komur, Baran; Aydogmus, Suavi; Kesiktas, Fatma Nur

    2017-02-01

    This study was performed to compare the efficacy of treatment in three groups of patients with knee osteoarthritis (OA) given an intra-articular injection of platelet-rich plasma (PRP), hyaluronic acid (HA) or ozone gas. A total of 102 patients with mild-moderate and moderate knee OA who presented at the polyclinic with at least a 1-year history of knee pain and VAS score ≥4 were randomly separated into three groups. Group 1 (PRP group) received intra-articular injection of PRP × 2 doses, Group 2 (HA group) received a single dose of HA, and Group 3 (Ozone group) received ozone × four doses. Weight-bearing anteroposterior-lateral and Merchant's radiographs of both knees were evaluated. WOMAC and VAS scores were applied to all patients on first presentation and at 1, 3, 6 and 12 months. At the end of the 1st month after injection, significant improvements were seen in all groups. In the 3rd month, the improvements in WOMAC and VAS scores were similar in Groups 1 and 2, while those in Group 3 were lower (p injections, as the application alone was sufficient to provide at least 12 months of pain-free daily living activities. Therapeutic study, Level I.

  18. Hyaluronic acid versus saline intra-articular injections for amelioration of chronic knee osteoarthritis: A canine model.

    Science.gov (United States)

    Pashuck, Troy D; Kuroki, Keiichi; Cook, Cristi R; Stoker, Aaron M; Cook, James L

    2016-10-01

    The objective of this study was to assess the safety and efficacy of intra-articular injections of hyaluronic acid (HA) versus saline for symptomatic treatment of osteoarthritis (OA). Twenty-five adult purpose-bred dogs underwent meniscal release of one knee. Clinical, arthroscopic, and radiographic signs of OA were confirmed in all dogs prior to treatment. Dogs were randomized into five groups: HA-1 (n = 5), HA-3 (n = 5), HA-5 (n = 5), Saline-1 (n = 5), and Saline-3 (n = 5). Each dog received intra-articular injections of the respective substance into the affected knee at the pre-determined time points. Dogs were assessed for heat, swelling, and erythema after each injection and for lameness, pain, effusion, range of motion, kinetics, radiographic OA scoring, and arthroscopic scoring prior to treatment and for 6 months after injection. Dogs were then humanely euthanatized and the knees assessed grossly and histologically. Only mild heat, swelling, and/or erythema were noted in some dogs following injection and resolved within 1 week. Dogs treated with HA-1, HA-3, and HA-5 were significantly (p injection protocols were safe, superior to saline for short-term amelioration of symptoms associated with chronic OA, and can be translated to human OA treatment. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1772-1779, 2016. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  19. Hyaluronic acid-coated bovine serum albumin nanoparticles loaded with brucine as selective nanovectors for intra-articular injection

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    Chen Z

    2013-10-01

    Full Text Available Zhipeng Chen,* Juan Chen,* Li Wu, Weidong Li, Jun Chen, Haibo Cheng, Jinhuo Pan, Baochang CaiDepartment of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, People's Republic of China*These authors contributed equally to this workObjective: To evaluate the potential of hyaluronic acid (HA-coated bovine serum albumin nanoparticles (BSANPs as a novel chondrocyte-targeting drug-delivery nanomedicine.Methods: The HA-BSANPs were characterized by dynamic light scattering, transmission electron microscopy, differential scanning calorimetry, and X-ray diffraction. Fluorescence imaging was used to visualize the distribution of nanoparticles after intra-articular injection. The chondrocyte-targeting efficiency and cellular uptake mechanism of HA-BSANPs were investigated using endocytic inhibitors.Results: HA-BSANPs were successfully prepared with HA coating the surface and amorphous drug in the core. Compared with BSANPs, HA-BSANPs exhibited improved uptake by chondrocytes through a receptor-mediated active uptake mechanism. The endocytosis process of BSANPs and HA-BSANPs involved clathrin-mediated endocytosis, caveolae-mediated endocytosis, and macropinocytosis. No apparent thickening or hyperplasia of the synovium was observed in either BSANPs or HA-BSANPs. The HA-BSANPs could reside in the articular cavity of rats for more than 14 days, which was significantly longer than BSANPs.Conclusion: HA-BSANPs are a promising carrier for articular-related diseases due to elongated articular residence and improved chondrocytic accumulation.Keywords: chondrocyte, intra-articular injection, hyaluronic acid, BSA, nanoparticles

  20. Inflammatory effects of autologous, genetically modified autologous, allogeneic, and xenogeneic mesenchymal stem cells after intra-articular injection in horses.

    Science.gov (United States)

    Pigott, J H; Ishihara, A; Wellman, M L; Russell, D S; Bertone, A L

    2013-01-01

    To compare the clinical and inflammatory joint responses to intra-articular injection of bone marrow-derived mesenchymal stem cells (MSC) including autologous, genetically modified autologous, allogeneic, or xenogeneic cells in horses. Six five-year-old Thoroughbred mares had one fetlock joint injected with Gey's balanced salt solution as the vehicle control. Each fetlock joint of each horse was subsequently injected with 15 million MSC from the described MSC groups, and were assessed for 28 days for clinical and inflammatory parameters representing synovitis, joint swelling, and pain. There were not any significant differences between autologous and genetically modified autologous MSC for synovial fluid total nucleated cell count, total protein, interleukin (IL)-6, IL-10, fetlock circumference, oedema score, pain-free range-of-motion, and soluble gene products that were detected for at least two days. Allogeneic and xenogeneic MSC produced a greater increase in peak of inflammation at 24 hours than either autologous MSC group. Genetically engineered MSC can act as vehicles to deliver gene products to the joint; further investigation into the therapeutic potential of this cell therapy is warranted. Intra-articular MSC injection resulted in a moderate acute inflammatory joint response that was greater for allogeneic and xenogeneic MSC than autologous MSC. Clinical management of this response may minimize this effect.

  1. Changes in concentrations of haemostatic and inflammatory biomarkers in synovial fluid after intra-articular injection of lipopolysaccharide in horses

    DEFF Research Database (Denmark)

    Andreassen, Stine Mandrup; Vinther, Anne Mette Lindberg; Nielsen, Søren Saxmose

    2017-01-01

    BACKGROUND: Septic arthritis is a common and potentially devastating disease characterized by severe intra-articular (IA) inflammation and fibrin deposition. Research into equine joint pathologies has focused on inflammation, but recent research in humans suggests that both haemostatic and inflam......BACKGROUND: Septic arthritis is a common and potentially devastating disease characterized by severe intra-articular (IA) inflammation and fibrin deposition. Research into equine joint pathologies has focused on inflammation, but recent research in humans suggests that both haemostatic...... and inflammatory pathways are activated in the joint compartment in arthritic conditions. The aim of this study was to characterize the IA haemostatic and inflammatory responses in horses with experimental lipopolysaccharide (LPS)-induced joint inflammation. Inflammation was induced by IA injection of LPS into one...... antebrachiocarpal joint of six horses. Horses were evaluated clinically with subjective grading of lameness, and blood and synovial fluid (SF) samples were collected at post injection hours (PIH) -120, -96, -24, 0, 2, 4, 8, 16, 24, 36, 48, 72 and 144. Total protein (TP), white blood cell counts (WBC), serum amyloid...

  2. Effects of intraarticular contrast media on synovial membrane and cartilage: An electron microscopic evaluation in rabbit knees

    International Nuclear Information System (INIS)

    Kose, N.; Inan, U.; Omeroglu, H.; Seber, S.; Baycu, C.; Omeroglu, H.

    2007-01-01

    To evaluate the histological and ultrastructural alterations in rabbit knee joint cartilage and synovia induced by intraarticular injections of 2 water soluble contrast agents. The study was conducted at the Department of Orthopedics and Traumatology, Medical Faculty, Osmangazi University, Eskisehir, Turkey in January 2002. To examine the effect of contrast agents on articular cartilage and synovial membrane, rabbit model was used. Specimens from 62 knee joints were examined by light microscopy and transmission electron microscopy one hour, one day, one week and 2 weeks after intraarticular administration of gadolinium-diethylenetriamine pentaacetic acid, iopromide or saline. In the knees injected with saline, light microscopic changes of the synovium consisted of edema only. Edema and hyperemia were seen in contrast agent injected knees. Ultrastructurally, numerous and large pinocytotic vesicles in A cells of the synovial membrane were seen in contrast agent injected groups. In the knees injected with saline the cartilage were ultrastructurally normal but contrast agent injected knees showed increased activation of chondrocytes with increase of dense glycogen accumulation, large lipid vacuoles and matrix material. There were very rare pycnotic cells in these samples. The rating scale has been used and the means of the total scores were determined for the groups. The effects of contrast agents reduced gradually on the cartilage and synovium in general but did not become completely normal in the observation period. (author)

  3. Intra-articular TSG-6 delivery from heparin-based microparticles reduces cartilage damage in a rat model of osteoarthritis.

    Science.gov (United States)

    Tellier, Liane E; Treviño, Elda A; Brimeyer, Alexandra L; Reece, David S; Willett, Nick J; Guldberg, Robert E; Temenoff, Johnna S

    2018-05-01

    As a potential treatment for osteoarthritis (OA), we have developed injectable and hydrolytically degradable heparin-based biomaterials with tunable sulfation for the intra-articular delivery of tumor necrosis factor-alpha stimulated gene-6 (TSG-6), a protein known to inhibit plasmin which may degrade extracellular matrix within OA joints. We first assessed the effect of heparin sulfation on TSG-6 anti-plasmin activity and found that while fully sulfated (Hep) and heparin desulfated at only the N position (Hep-N) significantly enhanced TSG-6 bioactivity in vitro, fully desulfated heparin (Hep-) had no effect, indicating that heparin sulfation plays a significant role in modulating TSG-6 bioactivity. Next, TSG-6 loaded, degradable 10 wt% Hep-N microparticles (MPs) were delivered via intra-articular injection into the knee at 1, 7, and 15 days following medial meniscal transection (MMT) injury in a rat model. After 21 days, cartilage thickness, volume, and attenuation were significantly increased with soluble TSG-6, indicating degenerative changes. In contrast, no significant differences were observed with TSG-6 loaded MP treatment, demonstrating that TSG-6 loaded MPs reduced cartilage damage following MMT injury. Ultimately, our results indicate that Hep-N can enhance TSG-6 anti-plasmin activity and that Hep-N-based biomaterials may be an effective method for TSG-6 delivery to treat OA.

  4. MR imaging of the intraarticular disk of the acromioclavicular joint: a comparison with anatomical, histological and in-vivo findings

    Energy Technology Data Exchange (ETDEWEB)

    Heers, Guido; Goetz, Juergen; Schubert, Thomas; Schachner, Henrik; Neumaier, Ulrich; Grifka, Joachim; Hedtmann, Achim [Orthopaedische Universitaetsklinik Regensburg, Asklepios Klinikum Bad Abbach, Bad Abbach (Germany)

    2007-01-15

    To characterize MRI features of the intraarticular disk of the acromioclavicular joint. We studied the appearance of 11 acromioclavicular joints of six cadavers (subjects aged 57-89 years at the time of death) and six healthy shoulders on T1-weighted, T2 (TSE)-weighted, STIR and PD (fat saturated) magnetic resonance imaging (MRI) and compared the findings with observations during dissection and histological examination. Macroscopic examinations showed two wedge-shaped disks underneath the superior and above the inferior joint capsule in nine specimens. In two specimens the acromioclavicular joints were degenerated. Histologically, the disk tissue consisted of fibrocartilage whereas the joint cartilage was partly degenerated, containing zones of fibrocartilage amidst degenerated hyaline cartilage, which may explain the similar signal intensity of both structures in all sequences used. MR appearance of the intraarticular structures of the acromioclavicular joint was similar in cadaveric and healthy shoulders. The difficulties related to imaging the acromioclavicular joint may be explained by the anatomy. Similar signal intensity of cartilage and disk may be explained by their similar histological structure (fibrocartilage). MRI findings should be interpreted with respect to the variable anatomy. These results may serve as a basis for further radiological studies of the acromioclavicular joint. (orig.)

  5. MR imaging of the intraarticular disk of the acromioclavicular joint: a comparison with anatomical, histological and in-vivo findings

    International Nuclear Information System (INIS)

    Heers, Guido; Goetz, Juergen; Schubert, Thomas; Schachner, Henrik; Neumaier, Ulrich; Grifka, Joachim; Hedtmann, Achim

    2007-01-01

    To characterize MRI features of the intraarticular disk of the acromioclavicular joint. We studied the appearance of 11 acromioclavicular joints of six cadavers (subjects aged 57-89 years at the time of death) and six healthy shoulders on T1-weighted, T2 (TSE)-weighted, STIR and PD (fat saturated) magnetic resonance imaging (MRI) and compared the findings with observations during dissection and histological examination. Macroscopic examinations showed two wedge-shaped disks underneath the superior and above the inferior joint capsule in nine specimens. In two specimens the acromioclavicular joints were degenerated. Histologically, the disk tissue consisted of fibrocartilage whereas the joint cartilage was partly degenerated, containing zones of fibrocartilage amidst degenerated hyaline cartilage, which may explain the similar signal intensity of both structures in all sequences used. MR appearance of the intraarticular structures of the acromioclavicular joint was similar in cadaveric and healthy shoulders. The difficulties related to imaging the acromioclavicular joint may be explained by the anatomy. Similar signal intensity of cartilage and disk may be explained by their similar histological structure (fibrocartilage). MRI findings should be interpreted with respect to the variable anatomy. These results may serve as a basis for further radiological studies of the acromioclavicular joint. (orig.)

  6. Adrenal Insufficiency Caused by Locally Applied Glucocorticoids-Myth or Fact?

    DEFF Research Database (Denmark)

    Dinsen, Stina; Klose, Marianne; Rasmussen, Åse Krogh

    2015-01-01

    Case-reports have made it evident that both inhaled, percutaneous, intranasal, intraarticular and ophthalmic administered glucocorticoids have the potential to cause life threatening adrenal insufficiency. With few and sometimes conflicting data and study methodology the prevalence of adrenal...... insufficiency secondary to locally applied glucocorticoids is not clear. Adrenal insufficiency can only be correctly evaluated by a stimulation test, and has by this procedure been reported in up to 40-50% of patients treated with high-dose inhaled glucocorticoids. Medium- to low-dose inhaled glucocorticoids...... have been shown to cause adrenal suppression in 0-16% of patients. Glucocorticoid creams and nasal glucocorticoids can cause adrenal insufficiency, also when used within prescribed doses, but the frequency seems to be less than with inhaled glucocorticoids. Intraarticularly administered glucocorticoids...

  7. Product Differences in Intra-articular Hyaluronic Acids for Osteoarthritis of the Knee.

    Science.gov (United States)

    Altman, Roy D; Bedi, Asheesh; Karlsson, Jon; Sancheti, Parag; Schemitsch, Emil

    2016-08-01

    Knee osteoarthritis (OA) is a common and often disabling joint disorder among adults that may result in impaired activity and daily function. A variety of treatment options are currently available and prescribed for knee OA depending on the severity of the disorder and physician preference. Intra-articular hyaluronic acid (IA-HA) injection is a treatment for knee OA that reportedly provides numerous biochemical and biological benefits, including shock absorption, chondroprotection, and anti-inflammatory effects within the knee. Clarity is needed as to whether the available IA-HA products should be considered for therapy as a group or whether there are significant differences in the products that need to be considered in treatment of OA of the knee. To determine whether there are differences in efficacy and safety with respect to intrinsic properties of available IA-HA injections for knee OA. Meta-analysis. A comprehensive literature search of the Medline, EMBASE, and PubMed databases was conducted for all existing randomized trials of IA-HA. The primary outcome measure analyzed was the mean pain score at the reported follow-up nearest to 26 weeks after injection. Pooled efficacy and safety results were recorded for subgroupings of HA product characteristics. A total of 68 studies were included for analysis. Products with an average molecular weight ≥3000 kDa provided favorable efficacy results when compared with products of an average molecular weight injection site than did avian-derived HA products, while high-molecular-weight products demonstrated the highest rate of injection site flare-up. Despite similarities, IA-HA products should not be treated as a group, as there are differences in IA-HA products that influence both efficacy and safety. In the available literature, IA-HA products with a molecular weight ≥3000 kDa and those derived from biological fermentation relate to superior efficacy and safety-factors that may influence selection an IA-HA product

  8. A randomised controlled trial for the effectiveness of intra-articular Ropivacaine and Bupivacaine on pain after knee arthroscopy: the DUPRA (DUtch Pain Relief after Arthroscopy)-trial

    NARCIS (Netherlands)

    Campo, M. M.; Kerkhoffs, G. M. M. J.; Sierevelt, I. N.; Weeseman, R. R.; van der Vis, H. M.; Albers, G. H. R.

    2012-01-01

    In this double-blinded, randomised clinical trial, the aim was to compare the analgesic effects of low doses of intra-articular Bupivacaine and Ropivacaine against placebo after knee arthroscopy performed under general anaesthesia. A total of 282 patients were randomised to 10 cc NaCl 0.9%, 10 cc

  9. Intra-articular injection of an antioxidant formulation did not improve structural degeneration in a rat model of post-traumatic osteoarthritis

    Directory of Open Access Journals (Sweden)

    Yau-Chuk Cheuk

    2017-01-01

    Conclusion: Intra-articular injection of an antioxidant formulation containing quercetin, vitamin C, and deferoxamine did not retard OA progression in advanced-stage OA. Future studies should aim to determine whether giving antioxidants in early OA, with prolonged drug retention, would be effective in retarding OA progression.

  10. Short- and long-term efficacy of intra-articular injections with betamethasone as part of a treat-to-target strategy in early rheumatoid arthritis

    DEFF Research Database (Denmark)

    Hetland, Merete Lund; Østergaard, Mikkel; Ejbjerg, Bo

    2012-01-01

    To investigate the short-term and long-term efficacy of intra-articular betamethasone injections, and the impact of joint area, repeated injections, MRI pathology, anticyclic citrullinated peptide (CCP) and immunoglobulin M rheumatoid factor (IgM-RF) status in patients with early rheumatoid arthr...

  11. Ultrasound-guided intraarticular injection for MR arthrography of the shoulder; Ultraschallgesteuerte intraartikulaere Kontrastmittelapplikation fuer die MR-Arthrografie der Schulter

    Energy Technology Data Exchange (ETDEWEB)

    Schaeffeler, Christoph; Bruegel, M.; Waldt, S.; Rummeny, E.J.; Woertler, K. [Inst. fuer Roentgendiagnostik, Klinikum rechts der Isar der Technischen Univ. Muenchen (Germany)

    2010-03-15

    Purpose: To evaluate ultrasound guidance for intraarticular contrast injection via an anterolateral approach in comparison with fluoroscopic guidance. Materials and Methods: Contrast agent injection was performed in 40 consecutive patients, 20 under sonographic guidance and 20 under fluoroscopic guidance. None of the patients had previous shoulder surgery. The procedure time was measured and the efficiency of joint distension, incidence of extravasation and intraarticular air on the consecutive MR arthrograms were assessed by three blinded radiologists with musculoskeletal radiology experience. Statistical analysis was performed using the Kruskal-Wallis test. Results: Intraarticular contrast injection was successfully accomplished in all 40 patients. Subsequent MR arthrograms did not show any significant difference between sonographic and fluoroscopic guidance with respect to diagnostic quality, joint distension (p = 0.6665), intraarticular air bubbles (p = 0.1567) and occurrence of contrast extravasation (p = 0.8565). The mean duration of ultrasound-guided injection was 7:30 min compared to a shorter procedure time of 4:15 min for fluoroscopic guidance. In both groups, no procedural complications were observed. Conclusion: Ultrasound-guided injection for MR arthrography of the shoulder via an anterolateral approach represents a simple, safe, and effective technique which yields comparable results to those of injection under fluoroscopic guidance, but is slightly more time-consuming. (orig.)

  12. Periarticular Liposomal Bupivacaine Injection Versus Intra-Articular Bupivacaine Infusion Catheter for Analgesia After Total Knee Arthroplasty: A Double-Blinded, Randomized Controlled Trial.

    Science.gov (United States)

    Smith, Eric B; Kazarian, Gregory S; Maltenfort, Mitchell G; Lonner, Jess H; Sharkey, Peter F; Good, Robert P

    2017-08-16

    Intra-articular bupivacaine hydrochloride (HCl) infusion catheters and periarticular injections of liposomal bupivacaine are often used as postoperative local anesthetics. The purpose of this study was to compare the efficacies of these local anesthetics following total knee arthroplasty. This study was a superiority trial with a randomized, controlled, double-blinded design. Patients were randomly assigned to either delivery of bupivacaine HCl by the ON-Q* Pain Relief System pump (n = 96) or by an injection of Exparel (liposomal bupivacaine) (n = 104). The primary outcome of this study was cumulative narcotic consumption on postoperative days 0 through 3. Narcotic consumption data were collected retrospectively from in-hospital records while patients were in the hospital. Following discharge, narcotic consumption data were gathered from patient surveys, as were secondary outcomes measures. We did not identify greater narcotic use in the ON-Q* group compared with the Exparel group (p = 0.641). The mean difference between the groups was 0.5 morphine equivalent (95% confidence interval [CI] = -1.7 to +2.8), with the ON-Q* group consuming an average 10.4 morphine equivalents (95% CI = 8.7 to 12.0) compared with 10.9 (95% CI = 9.3 to 12.5) in the Exparel group. There were no significant differences between groups with regard to any of the secondary measures of pain with the exception of pain while walking and pain with physical therapy (p = 0.019 and p = 0.010, respectively), both of which showed an approximately 1-point difference in favor of the ON-Q* group on a visual analog scale (VAS). There were also no differences in the postoperative side effects, including nausea, constipation, or vomiting, or in the rates of study-related complications, patient satisfaction, or length of hospital stay. Exparel did not have superior efficacy compared with the ON-Q* Pain Relief System as reflected by narcotic consumption, our primary outcome. There were small significant

  13. Efedrina versus fenilefrina: prevenção de hipotensão arterial durante anestesia raquídea para cesariana e efeitos sobre o feto Efedrina versus fenilefrina: prevención de hipotensión arterial durante anestesia raquidea para cesárea y efectos sobre el feto Ephedrine versus phenylephrine: prevention of hypotension during spinal block for cesarean section and effects on the fetus

    Directory of Open Access Journals (Sweden)

    Edno Magalhães

    2009-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A hipotensão arterial durante a anestesia raquídea para cesariana deve-se ao bloqueio simpático e compressão aorto-cava pelo útero e pode ocasionar efeitos deletérios para o feto e a mãe. A efedrina e fenilefrina melhoram o retorno venoso após bloqueio simpático durante anestesia raquídea. O objetivo deste estudo foi comparar a eficácia da efedrina e da fenilefrina em prevenir e tratar a hipotensão arterial materna durante anestesia raquídea e avaliar seus efeitos colaterais e alterações fetais. MÉTODO: Sessenta pacientes, submetidas à anestesia raquídea com bupivacaína e sufentanil para cesariana, foram divididas aleatoriamente em dois grupos para receber, profilaticamente, efedrina (Grupo E, n = 30, dose = 10 mg ou fenilefrina (Grupo F, n = 30, dose = 80 µg. Hipotensão arterial (pressão arterial menor ou igual a 80% da medida basal foi tratada com bolus de vasoconstritor com 50% da dose inicial. Foram avaliados: incidência de hipotensão arterial, hipertensão arterial reativa, bradicardia e vômitos, escore de Apgar no primeiro e quinto minutos e gasometria do cordão umbilical. RESULTADOS: A dose média de efedrina foi 14,8 ± 3,8 mg e 186,7 ± 52,9 µg de fenilefrina. Os grupos foram semelhantes quanto aos parâmetros demográficos e incidência de vômitos, bradicardia e hipertensão arterial reativa. A incidência de hipotensão arterial foi de 70% no Grupo E e 93% no Grupo F (p JUSTIFICATIVA Y OBJETIVOS: La hipotensión arterial durante la anestesia raquídea para cesárea se debe al bloqueo simpático y a la compresión aortocava por el útero y puede ocasionar efectos malignos para el feto y su madre. La efedrina y fenilefrina mejoran el retorno venoso después del bloqueo simpático durante la anestesia raquídea. El objetivo de este estudio fue comparar la eficacia de la efedrina y de la fenilefrina en prevenir y tratar la hipotensión arterial materna durante la anestesia raquídea y

  14. ANESTESIA PARA AMPUTACIÓN SUPRACONDÍLEA EN PACIENTE CON SÍNDROME CORONARIO AGUDO / Anesthesia for supracondylar amputation in patient with acute coronary syndrome

    Directory of Open Access Journals (Sweden)

    Marilyn Ramírez Méndez

    2012-03-01

    Full Text Available Resumen La insuficiencia arterial periférica es una enfermedad que se asocia a factores de riesgo aterogénico reconocidos, y es más frecuente en personas con hiperlipidemia, diabetes mellitus y hábito de fumar. Se presenta el caso de una mujer de 67 años de edad, con antecedentes de hipertensión arterial, diabetes mellitus e infarto de miocardio antiguo, que ingresa por signos de inflamación aguda del miembro inferior derecho como consecuencia de una insuficiencia arterial periférica. A los 8 días del ingreso presentó un síndrome coronario agudo sin elevación del segmento ST, con fallo de bomba Killip II, y una vez compensada fue anunciada para amputación supracondílea de urgencia, debido a una gangrena isquémica. Se decidió utilizar anestesia espinal subaracnoidea selectiva del miembro inferior derecho, a cual se aplicó sin complicaciones y favoreció el adecuado desarrollo de la cirugía planificada. A las 72 horas la paciente fue egresada de la UCI, sin síntomas cardiovasculares y compensación metabólica. / Abstract Peripheral arterial insufficiency is a disease that is associated with known atherogenic risk factors, and is more common in people with hyperlipidemia, diabetes mellitus and smoking habit. A case of a 67-year-old woman with a history of hypertension, diabetes mellitus and old myocardial infarction is presented. She was admitted for signs of acute inflammation of the right leg due to peripheral arterial insufficiency. 8 days after admission she presented an acute coronary syndrome without ST segment elevation with pump failure (Killip class II, and once compensated she was scheduled for emergency supracondylar amputation due to ischemic gangrene. It was decided to use selective spinal subarachnoid from the right leg, which was applied without complications and favored the proper development of the planned surgery. At 72 hours, the patient was discharged from the ICU, with metabolic compensation and without

  15. Intra-articular injection of hyaluronic acid is not superior to saline solution injection for ankle arthritis: a randomized, double-blind, placebo-controlled study.

    Science.gov (United States)

    DeGroot, Henry; Uzunishvili, Sofia; Weir, Robert; Al-omari, Ali; Gomes, Bruna

    2012-01-04

    Intra-articular injections of hyaluronic acid are potentially useful to treat ankle osteoarthritis, yet their effectiveness has not been proven. Both single and multiple-dose treatments for ankle arthritis with use of various hyaluronic acid products have been recommended, but few high-quality studies have been published. The aim of this study was to compare the effectiveness of a single intra-articular injection of hyaluronic acid with a single intra-articular injection of normal saline solution (placebo) for osteoarthritis of the ankle. Sixty-four patients with ankle osteoarthritis who met all study criteria were randomly assigned to a single intra-articular injection of 2.5 mL of low-molecular-weight, non-cross-linked hyaluronic acid or a single intra-articular injection of 2.5 mL of normal saline solution. The primary outcome measure was the change from baseline in the American Orthopaedic Foot & Ankle Society (AOFAS) clinical rating score at the six-week and twelve-week follow-up examination. Secondary outcome measures included the Ankle Osteoarthritis Scale score and patient-reported pain with use of a visual analog pain scale. Of the sixty-four patients randomized and treated, eight patients withdrew, leaving fifty-six patients who completed the entire study. There was one mild adverse event (1.6%) among the sixty-four patients. At six weeks and twelve weeks, the mean AOFAS scores in the hyaluronic acid group had improved from baseline by 4.9 and 4.9 points, respectively, whereas the mean AOFAS scores in the placebo group initially worsened by 0.4 point at six weeks and then improved by 5.4 points at twelve weeks. While the change at twelve weeks from baseline was substantial for both groups, the between-group differences were not significant. We found that a single intra-articular injection of low-molecular-weight, non-cross-linked hyaluronic acid is not demonstrably superior to a single intra-articular injection of saline solution for the treatment of

  16. A comparative study on the impact of intra-articular injections of hyaluronic acid, tenoxicam and betametazon on the relief of temporomandibular joint disorder complaints.

    Science.gov (United States)

    Gencer, Zeliha Kapusuz; Özkiriş, Mahmut; Okur, Aylin; Korkmaz, Murat; Saydam, Levent

    2014-10-01

    The aim of this study was to compare the efficacy of intra-articular injections of three different agents with well known anti-inflammatory properties. Between April 2010 and January 2013 a total of 100 patients who were diagnosed as temporomandibular joint disorder in the Department of Otolaryngology at Bozok University School of Medicine were prospectively studied. Patients with symptoms of jaw pain, limited or painful jaw movement, clicking or grating within the joint, were evaluated with temporomandibular CT to investigate the presence of cartilage or capsule degeneration. In the study group there were 55 female and 45 male patients who were non-responders to conventional anti-inflammatory treatment for TMJ complaints. The patients were randomly divided into four groups consisting of a control group and three different groups who underwent intra-articular injection of one given anti-inflammatory agent for each group. We injected saline solution to intra-articular space in the control group. Of three anti-inflammatory agents including hyaluronic acid (HA, Hyalgan intra-articular injection, Sodium hyaluronate 10 mg/ml, 2 ml injection syringe, Bilim Pharmaceutical Company, Istanbul, Turkey); betamethasone (CS, Diprospan flacon, 7.0 mg betamethasone/1 ml, Schering-Plough Pharmaceutical Company, Istanbul, Turkey) and; tenoxicam (TX, Tilcotil flacon, 20 mg tenoxicam/ml, Roche Pharmaceutical Company, Istanbul, Turkey) were administered intra-articularly under, ultrasonographic guidance. Following the completion of injections the, changes in subjective symptoms were compared with visual analogue scales, (VAS) scores at 1st and 6th weeks' follow-up visits between four groups. The HA group did significantly better pain relief scores compared to the, other groups at 1st and 6th weeks (p 0.05). We found that HA produced better pain relief scores when compared to the other anti-inflammatory agents studied. The main disadvantage of HA is its relatively higher cost

  17. Comparison between oral and intra-articular antinociceptive effect of dexketoprofen and tramadol combination in monosodium iodoacetate-induced osteoarthritis in rats.

    Science.gov (United States)

    Cialdai, Cecilia; Giuliani, Sandro; Valenti, Claudio; Tramontana, Manuela; Maggi, Carlo Alberto

    2013-08-15

    Dexketoprofen and tramadol, alone or in combination, were evaluated after oral or intra-articular administration on knee osteoarthritis nociception induced by intra-articular (i.ar.) monosodium iodoacetate (MIA, 1 mg/25 µl) in the rat right knee while the left knee received saline (25 µl). Seven days after MIA treatment, dexketoprofen, tramadol, their combination or the vehicle were administered. Nociception was evaluated as alteration in hind limb weight distribution with Incapacitance tester at different time-points after drug administration. Oral dexketoprofen (0.1-1 mg/kg) or tramadol (0.5-5 mg/kg) induced maximal antinociception at 1 and 5 mg/kg, respectively. Their combination dose-dependently increased the intensity and duration of antinociception, that was additive and lasted up to 3 days. Also the intra-articular administration of dexketoprofen or tramadol (10-100 µg/25 µl) inhibited MIA-induced nociception, and the combination of the lower doses (10 µg/25 µl) produced a long lasting more than additive antinociceptive effect indicating a synergistic interaction between the two drugs. This effect was significantly reduced by naloxone (10 μg/25 μl, i.ar.) co-administered with both compounds. The intra-articular administration of both drugs at 10 µg/25 µl in the contralateral control knee joint provoked a marked synergistic antinociceptive effect indicating significant systemic diffusion through synovial membrane. The oral or intra-articular combination of dexketoprofen and tramadol produced additive or synergistic antinociceptive effects, respectively, in the model of MIA-induced osteoarthritis in rats, that might allow to obtain therapeutic advantages with lower side effects. © 2013 Elsevier B.V. All rights reserved.

  18. Anestesia em paciente com síndrome de Marshall-Smith: relato de caso Anestesia en paciente con síndrome de Marshall-Smith: relato de caso Anesthesia in a patient with Marshall-Smith syndrome: case report

    Directory of Open Access Journals (Sweden)

    Beatriz Lemos da Silva Mandim

    2007-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A síndrome Marshall-Smith é uma doença rara, caracterizada por dismorfismo facial, acelerada maturação óssea, atraso no desenvolvimento neuropsicomotor e anormalidade das vias aéreas. Os pacientes com essa síndrome apresentam grande probabilidade de complicações anestésicas, sobretudo com relação ao manejo das vias aéreas. Há poucos dados na literatura anestésica a respeito desta síndrome. O objetivo deste relato foi apresentar as dificuldades e a conduta anestésica em uma criança de 28 dias, portadora dessa síndrome, submetida à cirurgia para correção de atresia de coanas sob anestesia geral. RELATO DO CASO: Criança do sexo masculino, 28 dias de vida, 2,8 kg, submetida à anestesia geral para correção cirúrgica de atresia de coanas. Apresentava as características típicas da síndrome Marshall-Smith como tórax estreito, pectus escavatum, mãos e pés grandes, pescoço comprido, dismorfismo facial, palato alto e estreito e acelerada maturação óssea. A indução anestésica foi inalatória sob máscara com O2 a 100% associado ao sevoflurano. Devido à possibilidade de intubação difícil, foi programada intubação traqueal com fibrobroncoscópio. Após intubação traqueal e ventilação assistida manual, foi administrado 1,5 mg de rocurônio e, passados dez minutos, o paciente apresentou bradicardia (80 bpm e hipóxia acentuada (30% de saturação de O2 e impossibilidade de ventilação manual através do tubo traqueal, sendo necessária a realização de traqueostomia de urgência, quando se optou por suspender o procedimento cirúrgico. CONCLUSÃO: Em casos de emergência anestésico-cirúrgica, nos quais a criança não ventila e não é possível a intubação traqueal, ocorre dessaturação com bradicardia associada e a tomada de decisão deve ser rápida e apropriada para garantir uma ventilação pulmonar adequada. Esses pacientes necessitam avaliação cuidadosa das vias a

  19. The John N. Insall Award: Do Intraarticular Injections Increase the Risk of Infection After TKA?

    Science.gov (United States)

    Bedard, Nicholas A; Pugely, Andrew J; Elkins, Jacob M; Duchman, Kyle R; Westermann, Robert W; Liu, Steve S; Gao, Yubo; Callaghan, John J

    2017-01-01

    Infection after total knee arthroplasty (TKA) can result in disastrous consequences. Previous research regarding injections and risk of TKA infection have produced conflicting results and in general have been limited by small cohort size. The purpose of this study was to evaluate if intraarticular injection before TKA increases the risk of postoperative infection and to identify if time between injection and TKA affect the risk of TKA infection. The Humana data set was reviewed from 2007 to 2014 for all patients who received a knee injection before TKA. Current Procedural Terminology (CPT) codes and laterality modifiers were used to identify patients who underwent knee injection followed by ipsilateral TKA. Postoperative infection within 6 months of TKA was identified using International Classification of Diseases, 9 th Revision/CPT codes that represent two infectious endpoints: any postoperative surgical site infection (encompasses all severities of infection) and operative intervention for TKA infection (surrogate for deep TKA infection). The injection cohort was stratified into 12 subgroups by monthly intervals out to 12 months corresponding to the number of months that had elapsed between injection and TKA. Risk of postoperative infection was compared between the injection and no injection cohorts. In total, 29,603 TKAs (35%) had an injection in the ipsilateral knee before the TKA procedure and 54,081 TKA cases (65%) did not. The PearlDiver database does not currently support line-by-line output of patient data, and so we were unable to perform a multivariate analysis to determine whether other important factors may have varied between the study groups that might have had a differential influence on the risk of infection between those groups. However, the Charlson Comorbidity index was no different between the injection and no injection cohorts (2.9 for both) suggesting similar comorbidity profiles between the groups. The proportion of TKAs developing any

  20. Comparação da anestesia geral e bloqueio do plexo cervical superficial em tireoidectomias parciais Comparison between general anesthesia and superficial cervical plexus block in partial thyroidectomies

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    Rui Celso Martins Mamede

    2008-02-01

    Full Text Available Tireoidectomia sob efeito de bloqueio do plexo cervical superficial (BPCS tem sofrido resistência. OBJETIVO: Comparar variáveis cirúrgicas e anestésicas, custos do tratamento e grau de satisfação de pacientes submetidos à hemitireoidectomia sob efeito de anestesia geral e BPCS. CASUÍSTICA E MÉTODOS: Foram 21 pacientes submetidos à anestesia geral (AG e outro tanto ao BPCS. Após sedação, no grupo com BPCS, usou-se marcaína com vasoconstritor, e quando necessário, lidocaína a 2% com vasoconstritor. Sedação intra-operatória com diazepam endovenoso e metoprolol para controle da PA e FC eram administradas quando necessário. Usou-se anestesia geral (AG segundo padronização do serviço. RESULTADOS: Foram significantes (pThyroidectomy under the effect of superficial cervical plexus block (SCPB has met resistance. AIM: to compare variables in patients submitted to hemithyroidectomy under the effect of general anesthesia (GA and SCPB. CASE REPORT AND METHODS: GA was used in 21 patients, and SCPB was used in another 21 patients. Following sedation, marcaine 0.5% with vasoconstrictor was used in the SCPB group. Intraoperative sedation with diazepam and metoprolol to control arterial pressure and cardiac frequency was given as needed. GA followed the standard method in the unit. RESULTS: We found significant results (p<0.05, Student’s t-test for surgery time (GA - 111.4 min; SCPB - 125.5 min, anesthesia time (GA - 154.1 min; SCPB - 488.6 min, time in the surgery room (GA - 15 min; SCPB - 1 min, treatment costs (GA - R$203.2; SCPB - R$87.4, presence of bradycardia (GA - 0; SCPB - 23.8% and laryngotracheal injury (GA - 51; SCPB - 0 %. We also found the following non-significant results: hospitalization time (GA - 17.3; SCPB - 15.1 hours; bleeding volume (GA - 41,9 g; SCPB - 47.6 g, size of the operative specimen (GA - 52.1 cm3; SCPB - 93.69 cm3 and patient satisfaction level (GA - 3.8; SCPB - 3.9. CONCLUSION: Although the incidence of

  1. Intra-articular bupivacaine after joint arthroplasty: a systematic review and meta-analysis of randomised placebo-controlled studies

    Science.gov (United States)

    Cui, Yang; Yang, Tuo; Zeng, Chao; Wei, Jie; Xie, Xi; Li, Liangjun; Ding, Xiang; Zhang, Yi; Lei, Guanghua

    2016-01-01

    Objectives To evaluate the efficacy and safety of intra-articular (IA) bupivacaine administered for pain relief after joint arthroplasty. Design Meta-analysis. Methods A systematic review was conducted to identify the randomised controlled trials using IA bupivacaine for postoperative pain relief from MEDLINE, Cochrane Library and EMBASE databases (up to October 2015). The standardised mean difference (SMD), the relative risk (RR) and their corresponding 95% CIs were calculated using the RevMan statistical software. Results A total of 11 randomised controlled trials were included. Statistically significant differences between IA bupivacaine and placebo were observed for the mean visual analogue scale (VAS) values (SMD −0.55; 95% CI −0.89 to −0.22; pbupivacaine after joint arthroplasty is effective for pain relief without increasing adverse effects. PMID:27406643

  2. Benefits and harms of locking plate osteosynthesis in intraarticular (OTA Type C) fractures of the proximal humerus: A systematic review

    DEFF Research Database (Denmark)

    Brorson, Stig; Rasmussen, Jeppe Vejlgaard; Frich, Lars Henrik

    2012-01-01

    stable plates in AO/OTA Type C fractures of the proximal humerus. METHODS: We conducted an iterative search in PubMed, Embase, Cochrane Library, Web of Science, Cinahl, and PEDro in all languages from 1999 to November 2010. Eligible studies should study the outcome for Type C fractures after primary...... according to study type and synthesised qualitatively. No randomised clinical trials were identified. Two comparative, observational studies reported a mean CS of 71 (relative to contralateral shoulder) and 75 (non-adjusted Constant Score) for Type C fractures. For all studies mean non-adjusted CS ranged......INTRODUCTION: Locking plate osteosynthesis of proximal humeral fractures are widely recommended and used, even in complex intraarticular fracture patterns such as AO/OTA Type C fractures. We systematically reviewed clinical studies assessing the benefits and harms of osteosynthesis with angle...

  3. Anestesia para ventriculostomia por via endoscópica para tratamento de hidrocefalia: relato de casos Anestesia para ventriculostomía por vía endoscópica para tratamiento de hidrocefalia: relato de casos Anesthesia for endoscopic ventriculostomy for the treatment of hydrocephalus: case report

    Directory of Open Access Journals (Sweden)

    Friederike Wolff Valadares

    2007-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A terceiro-ventriculostomia endoscópica está se tornando um procedimento de rotina entre as intervenções neurocirúrgicas infantis. Entretanto, relatos sobre anestesia para crianças submetidas a tais procedimentos ainda são escassos. O objetivo desta série de casos foi demonstrar os cuidados e a eficácia do método empregado. RELATO DOS CASOS: Foram avaliadas retrospectivamente 38 crianças abaixo de 2 anos que se submeteram à terceiro-ventriculostomia neuroendoscópica para tratamento de hidrocefalia obstrutiva no período de 1999 a 2004 no Biocor Instituto. Foram estudados o diagnóstico, comorbidades, idade, peso, técnica anestésica, monitorização e as complicações intra e pós-operatórias. Todos os pacientes, entre 1 semana e 20 meses, apresentavam hidrocefalia obstrutiva por compressão do aqueduto de etiologia variada. A indução anestésica em 35 crianças foi por via inalatória e por via venosa em três delas. A monitorização de 34 pacientes foi com eletrocardiograma, oxímetro de pulso, capnógrafo e termômetro esofágico, sendo quatro crianças monitorizadas com pressão arterial invasiva contínua. A manutenção da anestesia em 15 pacientes foi balanceada com fentanil e isoflurano e em outros 23 pacientes inalatória com isoflurano. Trinta e cinco crianças foram extubadas após o procedimento na sala cirúrgica e outras três no CTI. Seis pacientes foram encaminhados ao CTI após a extubação. Complicações observadas: disritmias cardíacas sem repercussão hemodinâmica no intra-operatório (seis casos. Dois pacientes tiveram sangramento intra-operatório, mas somente um deles demandou implante de derivação ventricular externa. As complicações no pós-operatório foram: vômitos (6, picos febris (4 convulsões (2, laringoespasmo (1 e estridor laríngeo (1. CONCLUSÕES: A terceiro-ventriculostomia apresenta baixa incidência de complicações mesmo em pacientes com menos de 24

  4. Anestesia para implante de marca-passo em paciente adulto com ventrículo único não-operado: relato de caso Anestesia para implante de marcapaso en paciente adulto con ventrículo único no operado: relato de caso Anesthesia for pacemaker implant in an adult patient with unoperated univentricular heart: case report

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    Adriano Bechara de Souza Hobaika

    2007-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Ventrículo único é anormalidade rara encontrada em cerca de 1% dos pacientes com cardiopatia congênita. Somente 11 casos de pacientes com ventrículo único não-operado e idade acima de 50 anos foram relatados na literatura. Este trabalho teve como objetivo descrever a conduta anestésica em paciente com ventrículo único para implante de marca-passo. RELATO DO CASO: Paciente do sexo feminino, 47 anos, com presença de dupla via de entrada do ventrículo esquerdo, L-transposição de grandes artérias e estenose subpulmonar, sem correção cirúrgica prévia, foi agendada para implante de marca-passo cardíaco definitivo seqüencial de duas câmaras. Ao MAPA apresentava bloqueio atrioventricular de segundo grau e uma freqüência cardíaca média de 45 bpm. Os exames pré-operatórios mostravam hematócrito de 57%, coagulograma normal, função ventricular preservada. A monitorização constou de oxímetro de pulso, ECG nas derivações D II e V5, PIA, capnógrafo e analisador de gases. Um marca-passo temporário transcutâneo foi disponibilizado no caso de bradicardia intensa. A anestesia foi induzida com fentanil (0,25 mg, etomidato (20 mg e atracúrio (35 mg. Quatro minutos após a indução, a freqüência cardíaca diminuiu para 30 bpm, sendo administrado 1 mg de atropina, com reversão da bradicardia. A anestesia foi mantida com sevoflurano a 2,5%, ar 60% e oxigênio 40%. O estado hemodinâmico e a saturação de oxigênio permaneceram estáveis. A paciente foi encaminhada à unidade de terapia intensiva estável e extubada ao final do procedimento. CONCLUSÕES: A conduta anestésica para implante de marca-passo em paciente de 47 anos com dupla via de entrada do ventrículo esquerdo e estenose subpulmonar não-operada foi adequada, haja vista que permitiu a realização do procedimento indicado.JUSTIFICATIVA Y OBJETIVOS: Ventrículo único es una anormalidad rara encontrada en aproximadamente 1% de los

  5. A treat-to-target strategy with methotrexate and intra-articular triamcinolone with or without adalimumab effectively reduces MRI synovitis, osteitis and tenosynovitis and halts structural damage progression in early rheumatoid arthritis

    DEFF Research Database (Denmark)

    Axelsen, Mette Bjørndal; Eshed, Iris; Hørslev-Petersen, Kim

    2014-01-01

    To investigate whether a treat-to-target strategy with methotrexate and intra-articular glucocorticosteroid injections suppresses MRI inflammation and halts structural damage progression in patients with early rheumatoid arthritis (ERA), and whether adalimumab provides an additional effect....

  6. Do intra-articular hyaluronic acid injections delay total knee replacement in patients with osteoarthritis - A Cox model analysis.

    Science.gov (United States)

    Delbarre, Angélique; Amor, Bernard; Bardoulat, Isabelle; Tetafort, Aymeric; Pelletier-Fleury, Nathalie

    2017-01-01

    This study aimed to describe patients treated for knee osteoarthritis between 2006 and 2013 in France and to compare the delay from diagnosis to total knee replacement between patients who received intra-articular hyaluronic acid injections and those who did not receive the injections. A second objective was to compare direct medical costs for ambulatory care between treatment groups. Patients were selected from a representative sample of the real world administrative claims database using an algorithm developed by experts from the scientific committee of the study. Data were matched with the medico-administrative database for hospital care. A Cox proportional hazards model was stratified for the treatment group and adjusted for available socio-demographic and medical covariates to compare restricted mean survival times at different time points (1, 3, 5 and 7.5 years) between groups. Costs were expressed in 2013 euros. A total of 14,782 patients were treated for knee osteoarthritis (67% women; mean age = 68 years). Among this population, 1,662 patients had total knee replacement (11.2%). At each time point, restricted mean survival time without total knee replacement was significantly higher (p-valueshyaluronic acid group, from +51 to +217 days at 1 and 7.5 years, respectively. For the year preceding total knee replacement, the means for total direct medical costs were similar between groups, €744 vs €805 for treatment and control groups, respectively, (p-value = 0.104). Intra-articular injections accounted for less than 10% of the total costs. This is the first retrospective longitudinal study involving knee osteoarthritis patients using medico-administrative databases in France. The results support the effectiveness of hyaluronic acid injections in delaying total knee replacement and show that patients treated with hyaluronic acid have similar direct medical costs for ambulatory care compared to patients treated with corticosteroids only.

  7. Clinical presentation of intra-articular osteoid osteoma of the hip and preliminary outcomes after arthroscopic resection: a case series

    Science.gov (United States)

    Rotter, Ben-Zion; Mintz, Douglas N; Kelly, Bryan T

    2018-01-01

    ABSTRACT Intra-articular osteoid osteoma (IAOO) of the hip is a relatively rare diagnosis, but one that can closely mimic symptomatic presentation of femoroacetabular impingement (FAI). Although there are multiple case reports of osteoid osteoma (OO) in the hip, we present the largest case series of hip IAOO treated with hip arthroscopy and discuss limited patient-reported outcomes after treatment with hip arthroscopy. We retrospectively identified patients diagnosed with IAOO of the hip with confirmatory computed tomography, magnetic resonance imaging or biopsy diagnoses of OO. We analyzed lesion location, main presenting symptoms, symptom duration and treatment undertaken. For the patients who underwent hip arthroscopy for treatment of their IAOO, we reviewed patient-reported outcome scores when available. Forty patients with confirmed IAOO were identified. Thirteen underwent excision with hip arthroscopy. The most common presenting symptom was groin pain. In limited patients who had pre- and post-operative outcome scores, we found significant improvements in modified Harris Hip Score (mHHS), Hip Outcome Score-Activity of Daily Living (HOS-ADL) and international Hip Outcomes Tool (iHot33) scores. Compared with patients undergoing hip arthroscopy for FAI alone, baseline mHHS, HOS-ADL, Hip Outcome Score–Sport-Specific Subscale and iHot33 scores were almost identical. We found that the presenting symptoms of hip IAOO closely mimic symptomatic FAI, including groin pain and anterior hip pain, so it is important to keep IAOO of the hip in the differential diagnosis of hip pain. Based on our experience, arthroscopy can be an effective treatment option for excision of intra-articular OO and is especially effective in patients with concomitant FAI in treating both pathologies. PMID:29423256

  8. Safety and efficacy of bi-annual intra-articular LBSA0103 injections in patients with knee osteoarthritis.

    Science.gov (United States)

    Lee, Jin Kyu; Choi, Chong-Hyuk; Oh, Kwang-Jun; Kyung, Hee-Soo; Yoo, Ju-Hyung; Ha, Chul-Won; Bin, Seong-Il; Kang, Seung-Baik; Kim, Myung Ku; Lee, Ju-Hong; Lee, Myung Chul

    2017-11-01

    The objective of this study is to assess the safety and efficacy of repeated intra-articular injection of high molecular weight hyaluronic acid (LBSA0103) at a 26-week interval, in patients with osteoarthritis of the knee. The study was an open-label, single arm, multicentre prospective trial conducted in patients with symptomatic knee osteoarthritis. The intervention consisted of two intra-articular injections of LBSA0103, with the second injection performed 26 weeks after the first injection. The primary outcome was the incidence of adverse drug reactions related to each injection. Assessment of efficacy of repeated injections in terms of maintenance of pain relief was a secondary objective of this study. Of the 185 patients screened, 174 patients received the first injection and 153 patients received both injections of LBSA0103. Nine adverse drug reactions occurred in seven patients (4.02%) after the first injection, while only one adverse drug reaction occurred (0.65%) after the second injection. As a secondary outcome measure, the improvements in the efficacy parameters including total WOMAC score and weight-bearing pain were all significant at both week 13 and 39 compared to the baseline value (P injection were consistent with those after the initial injection of LBSA0103 (between week 26 and week 39, P injection of LBSA0103 at a 26-week interval is safe without increased risk of adverse drug reactions. Additionally, LBSA0103 is effective in reduction of osteoarthritis knee pain and in maintenance of pain reduction for a 39-week period when a second injection is administered.

  9. Intra-articular injection of methylprednisolone for reducing pain in knee osteoarthritis: A systematic review and meta-analysis.

    Science.gov (United States)

    Tian, Kewei; Cheng, Huiguang; Zhang, Jiangtao; Chen, Ke

    2018-04-01

    To evaluate the efficacy and safety of intra-articular methylprednisolone for reducing pain in patients with knee osteoarthritis. We conduct electronic searches of Medline (1966-2017.11), PubMed (1966-2017.11), Embase (1980-2017.11), ScienceDirect (1985-2017.11), and the Cochrane Library (1900-2017.11) for randomized clinical trials comparing the use of methylprednisolone to treat knee osteoarthritis. The primary outcomes are Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain scores and WOMAC function scores. Each outcome was combined and calculated using the statistical software STATA 12.0. Fixed/random effect model was adopted based on the heterogeneity tested by I statistic. A total of 739 patients were analyzed across 4 randomized controlled trials (RCTs). The present meta-analysis revealed that there were significant differences between groups regarding the WOMAC pain scores at 4 weeks (WMD = -1.384, 95% CI: -1.975 to -0.793, P = .000), 12 weeks (WMD = -1.587, 95% CI: -2.489 to -0.685, P = .001), and 24 weeks (WMD = -1.563, 95% CI: -2.245 to -0.881, P = .000). Significant differences were identified in terms of physical function at 4 weeks (WMD = -7.925, 95% CI: -13.359 to -2.491, P = .004), 12 weeks (WMD = -7.314, 95% CI: -13.308 to -1.320, P = .117), and 24 weeks (WMD = -6.484, 95% CI: -11.256 to -1.711, P = .008). Intra-articular methylprednisolone injection was associated with an improved pain relief and physical function in patients with knee osteoarthritis. Additionally, no severe adverse effects were observed. Due to the limited quality of the evidence currently available, higher quality RCTs were required.

  10. Elbow dislocation with intra-articular fracture: the results of operative treatment without repair of the medial collateral ligament.

    Science.gov (United States)

    Forthman, Christopher; Henket, Marjolijn; Ring, David C

    2007-10-01

    To determine the effectiveness of a protocol for the treatment of fracture-dislocations of the elbow based on the concept that, if dislocation of the elbow with associated fractures can be made to resemble a simple elbow dislocation by repairing or reconstructing the fractured structures, repair of the medial collateral ligament (MCL) will not be necessary. Over a 5-year period, a single surgeon operated on 34 patients with a posterior dislocation of the elbow associated with one or more intra-articular fractures. The mean age of these 19 men and 15 women was 48 years. Associated fractures included the capitellum, trochlea, and lateral epicondyle in 3 patients; the olecranon in 1 patient; and the radial head in 30 patients (with concomitant fracture of the coronoid process-the so-called "terrible triad" of the elbow-in 22 patients, and concomitant fracture of the coronoid and olecranon in 1 patient). Operative treatment consisted of open reduction internal fixation (ORIF) or prosthetic replacement of all fractures and reattachment of the origin of the lateral collateral ligament (LCL) complex to the lateral epicondyle. The MCL was not repaired. Two patients (1 with a terrible triad injury and 1 with fracture of the capitellum and trochlea) had postoperative instability related to noncompliance, had reconstructive procedures, and were considered failures. An average of 32 months after injury, the remaining 32 patients regained an average of 120 degrees ulnohumeral motion and 142 degrees forearm rotation. Twenty-five of 34 patients (74%) had good or excellent results according to the system of Broberg and Morrey. Patients with terrible triad injuries had an average of 117 degrees ulnohumeral motion and 137 degrees forearm rotation, and 17 of 22 patients (77%) had good or excellent results. MCL repair is unnecessary in the treatment of dislocation of the elbow with associated intra-articular fractures, provided that the articular fractures and the LCL are repaired or

  11. Intra-articular morphine versus bupivacaine for knee motion among patients with osteoarthritis: randomized double-blind clinical trial

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    Miriam Bellini Gazi

    Full Text Available CONTEXT AND OBJECTIVE: Osteoarthritis causes pain and disability in a high percentage of elderly people. The aim of the present study was to assess the efficacy of intra-articular morphine and bupivacaine on the joint flexion and extension angles of patients with knee osteoarthritis. DESIGN AND SETTING: A randomized double-blind study was performed at a pain clinic of Universidade Federal de São Paulo. METHODS: Thirty-nine patients with pain for more than three months, of intensity greater than three on a numerical scale (zero to 10, were included. G1 patients received 1 mg (1 ml of morphine diluted in 9 ml of saline, intra-articularly, and G2 patients received 25 mg (10 ml of 0.25% bupivacaine without epinephrine. Pain was assessed on a numerical scale and knee flexion and extension angles were measured after administration of the drugs at rest and during movement. The total amount of analgesic supplementation using 500 mg doses of paracetamol was also determined. RESULTS: No significant difference in pain intensity was observed between G1 and G2. Significant decreases in pain at rest and during movement and significant increases in mean flexion and extension angles were observed in both groups, with no significant difference between the two groups. The mean total amount of paracetamol used over a seven-day period was 3578 mg in G1 and 5333 mg in G2 (P = 0.2355; Mann-Whitney test. CONCLUSION: The analgesic effects of 1 mg of morphine and 25 mg of 0.25% bupivacaine were similar among patients with osteoarthritis of the knee.

  12. The Effect of Intra-articular Injection of Autologous Microfragmented Fat Tissue on Proteoglycan Synthesis in Patients with Knee Osteoarthritis

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    Damir Hudetz

    2017-10-01

    Full Text Available Osteoarthritis (OA is one of the leading musculoskeletal disorders in the adult population. It is associated with cartilage damage triggered by the deterioration of the extracellular matrix tissue. The present study explores the effect of intra-articular injection of autologous microfragmented adipose tissue to host chondrocytes and cartilage proteoglycans in patients with knee OA. A prospective, non-randomized, interventional, single-center, open-label clinical trial was conducted from January 2016 to April 2017. A total of 17 patients were enrolled in the study, and 32 knees with osteoarthritis were assessed. Surgical intervention (lipoaspiration followed by tissue processing and intra-articular injection of the final microfragmented adipose tissue product into the affected knee(s was performed in all patients. Patients were assessed for visual analogue scale (VAS, delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC and immunoglobulin G (IgG glycans at the baseline, three, six and 12 months after the treatment. Magnetic resonance sequence in dGEMRIC due to infiltration of the anionic, negatively charged contrast gadopentetate dimeglumine (Gd-DTPA2− into the cartilage indicated that the contents of cartilage glycosaminoglycans significantly increased in specific areas of the treated knee joint. In addition, dGEMRIC consequently reflected subsequent changes in the mechanical axis of the lower extremities. The results of our study indicate that the use of autologous and microfragmented adipose tissue in patients with knee OA (measured by dGEMRIC MRI increased glycosaminoglycan (GAG content in hyaline cartilage, which is in line with observed VAS and clinical results.

  13. Anestesia subaracnóidea para cesariana em paciente portadora de esclerose múltipla: relato de caso Anestesia subaracnoidea para cesárea en paciente portadora de esclerosis múltiple: relato de caso Subarachnoid anesthesia for cesarean section in a patient with multiple sclerosis: case report

    Directory of Open Access Journals (Sweden)

    Fabiano Timbó Barbosa

    2007-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A esclerose múltipla é uma doença adquirida que se caracteriza por áreas desmielinizadas no encéfalo e na medula espinal. O quadro clínico depende das áreas anatômicas acometidas. As principais causas de morte são infecção, falência respiratória e estado de mal epiléptico. Ocorre em pacientes geneticamente predispostos após contato com fatores ambientais, principalmente os vírus. O objetivo desse relato foi apresentar a técnica anestésica adotada em paciente com esclerose múltipla submetida à cesariana. RELATO DO CASO: Paciente com 32 anos, 60 kg, portadora de esclerose múltipla, tratada com metilprednisolona, deu entrada no centro obstétrico para realização de cesariana. Após monitoração foi realizada anestesia subaracnóidea com bupivacaína a 0,5% hiperbárica (12,5 mg associada à morfina (0,1 mg. O procedimento evoluiu sem intercorrências e a paciente recebeu alta hospitalar 48 horas após o parto sem piora dos sintomas preexistentes. CONCLUSÕES: O presente caso sugere que a raquianestesia pode ser administrada em paciente portador de esclerose múltipla sem a ocorrência obrigatória de exacerbações agudas dos sintomas no período pós-operatório.JUSTIFICATIVA Y OBJETIVOS: La esclerosis múltiple es una enfermedad adquirida que se caracteriza por áreas desmielinizadas en el encéfalo y en la médula espinal. El cuadro clínico depende de las áreas anatómicas acometidas. Las principales causas de muerte son infección, falencia respiratoria y estado de mal epiléptico. Ocurre en pacientes genéticamente predispuestos después del contacto con factores ambientales, principalmente los virus. El objetivo de este relato fue presentar la técnica anestésica adoptada en paciente con esclerosis múltiple sometida a cesárea. RELATO DEL CASO: Paciente con 32 anos, 60 kg, portadora de esclerosis múltiple, tratada con metilprednisolona, entró en el centro obstétrico para realizaci

  14. Effects of constant rate infusion of anesthetic or analgesic drugs on general anesthesia with isoflurane: A retrospective study in 200 dogs Efeitos da infusão intravenosa contínua de fármacos anestésicos ou analgésicos sobre a anestesia geral com isoflurano: Estudo retrospectivo em 200 cães

    Directory of Open Access Journals (Sweden)

    Sofia de Amorim Cerejo

    2013-09-01

    Full Text Available Constant rate infusion (CRI shows several advantages in balanced anesthesia, such as reduction of requirement for inhaled anesthetics and control of pain. The most commonly used drugs in these protocols are local anesthetics, dissociative, and opioids, which may be administered alone or in combinations. We evaluated the records of 200 dogs that underwent various surgical procedures with anesthetic or analgesic CRI in the perioperative period during 2011 and 2012 at the Veterinary Hospital of Franca University (Unifran, and identified possible complications during the transoperative period. Records evaluated included clinical state, laboratory tests, drugs used in premedication and induction, and CRI protocol. Acepromazine and morphine were the main drugs used in premedication. Propofol was used to induce anesthesia alone or in combination with other agents. We evaluated records of the 25 different CRI protocols. Fentanyl was the main drug employed in CRI, either alone or in combination. There were 128 episodes of anesthetic complications during CRI;the most common were hypotension, hypertension, and tachycardia, which occurred in 43 (32%, 35 (26.3%, and 19 (14.2% dogs, respectively. Cardiac arrhythmia was reported in only 4 dogs. Signs of respiratory depression were present in dogs treated with 6 different CRI protocols. The consumption of isoflurane (vol % reduced between 15.7% and 21.05% after 30minutes of the CRI in the fentanyl and fentanyl–lidocaine–ketamine CRI groups (pO uso de técnicas de infusão contínua (IC possui inúmeras vantagens na anestesia balanceada, como a redução do requerimento de anestésicos inalatórios e controle da dor. Os fármacos mais comumente utilizados nestes protocolos são os anestésicos locais, dissociativos e opioides, que podem ser administrados isoladamente ou em associações. Foram avaliados os prontuários de 200 cães que foram submetidos a diversos procedimentos cirúrgicos com IC de anest

  15. Anestesia por isofluorano em eqüinos submetidos à infusão contínua de medetomidina ou xilazina Isoflurane anesthesia in horses during medetomidine or xilazine continuous infusion

    OpenAIRE

    Renata Gebara Sampaio Dória; Carlos Augusto Araújo Valadão; Paulo Aléscio Canola; Érica Cristina Bueno do Prado Guirro; Marina Ceccato Mendes; André Escobar; Gesiane Ribeiro; Cláudio Côrrea Natalini

    2009-01-01

    Avaliaram-se oito eqüinos sob anestesia geral inalatória com isofluorano (1CAM) e infusão contínua de xilazina (0,35mg kg-1h-1) ou medetomidina (3,5µg kg-1h-1), em relação à freqüência cardíaca, ritmo cardíaco, freqüência respiratória, pressão arterial, hemogasometria arterial e temperatura, nos tempos T0 (imediatamente antes do início da infusão contínua) e T10 ao T60 (intervalos de 10 minutos, após início da infusão contínua). Houve redução da freqüência cardíaca e da temperatura e el...

  16. Anestesia para correção cirúrgica de fístula de artéria coronária sem circulação extracorpórea: relato de caso

    Directory of Open Access Journals (Sweden)

    Raquel Reis Soares

    2011-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Descrita em 1865 por Krause ¹, a fístula de artéria coronária comunicando-se com cavidades cardíacas, artéria pulmonar ou seio coronário é muito rara. Representa 0,2% a 0,4 % das cardiopatias congênitas e 0,1% a 0,2% da população adulta submetida a angiografias coronarianas ². O objetivo deste relato é apresentar anestesia para cirurgia de fechamento de fístula coronária em procedimento eletivo, considerando suas particularidades. RELATO DE CASO: Paciente do sexo masculino com 59 anos, cuja fístula coronária foi diagnosticada durante investigação clínica de dor torácica progressiva e dispneia de longa data. O paciente foi submetido a uma correção cirúrgica de fístula de artéria coronária sob anestesia geral sem a utilização de circulação extracorpórea (CEC.O paciente evoluiu sem intercorrências, tendo alta hospitalar com melhora clínica em sete dias de pós-operatório. CONCLUSÕES: A fístula coronária é afecção rara, mas o anestesiologista pode deparar com esse tipo de paciente em situações distintas. É importante compreender sua fisiopatologia para abordar adequadamente o paciente no perioperatório, favorecendo seu melhor prognóstico.

  17. Reduced hospital stay and narcotic consumption, and improved mobilization with local and intraarticular infiltration after hip arthroplasty: a randomized clinical trial of an intraarticular technique versus epidural infusion in 80 patients

    DEFF Research Database (Denmark)

    Andersen, Karen Vestergaard; Pfeiffer-Jensen, Mogens; Haraldsted, Viggo

    2007-01-01

    infusion. METHODS: 80 patients undergoing elective THA under spinal block were randomly assigned to receive either (1) continuous epidural infusion (group E) or (2) infiltration around the hip joint with a mixture of 100 mL ropivacaine 2 mg/mL, 1 mL ketorolac 30 mg/mL, and 1 mL epinephrine 0.5 mg...

  18. Electrocardiographic study on geriatric dogs undergoing general anesthesia with isoflurane Estudo eletrocardiográfico em cães geriátricos submetidos à anestesia geral com isofluorano

    Directory of Open Access Journals (Sweden)

    Andreza Conti-Patara

    2009-04-01

    Full Text Available The purpose of this study was to clarify the degree of influence of anesthetic agents commonly used during anesthesia on the heart conduction systems of geriatric dogs, with or without the presence of electrocardiographic changes in the pre-anesthetic electrocardiogram and also to determine the possible causes of ST-segment and T-wave changes during anesthesia, by monitoring ventilation and oxygenation. 36 geriatric dogs were evaluated. In addition to electrocardiographic evaluation, the pre-anesthetic study included serum levels of urea, creatinine, total protein, albumin and electrolytes. The pre-anesthetic medication consisted of acepromazine (0.05mg kg-1 in association with meperidine (3.0mg kg-1 by IM injection. Anesthesia was induced with propofol (3.0 to 5.0mg kg-1 by IV injection and maintained with isoflurane in 100% oxygen. During the anesthesia, the animals were monitored by continued computerized electrocardiogram. Systemic blood pressure, heart rate, respiratory rate, end-tidal carbon dioxide, partial pressure of carbon dioxide in arterial blood, arterial oxygen saturation, partial pressure of arterial oxygen and oxygen saturation of hemoglobin were closely monitored. During maintenance anesthesia, normal sinus rhythm was more common (78%. ST-segment and T-wave changes during the anesthetic procedure were quite common and were related to hypoventilation. The use of isoflurane did not result in arrhythmia, being therefore a good choice for this type of animal; Electrocardiographic findings of ST-segment and T-wave changes during the maintenance anesthesia were evident in animals with hypercapnia, a disorder that should be promptly corrected with assisted or controlled ventilation to prevent complicated arrhythmias.Os objetivos deste estudo foram esclarecer a influência dos agentes anestésicos comumente utilizados durante a anestesia no sistema de condução cardíaco em cães idosos, com ou sem alterações eletrocardiográficas pr

  19. Intra-articular vs. systemic administration of etanercept in antigen-induced arthritis in the temporomandibular point. Part I: histological effects

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    Nyengaard Jens R

    2009-02-01

    Full Text Available Abstract Background Temporomandibular joint (TMJ arthritis in children causes alterations in craniomandibular growth. This abnormal growth may be prevented by an early anti-inflammatory intervention. We have previously shown that intra-articular (IA corticosteroid reduces TMJ inflammation, but causes concurrent mandibular growth inhibition in young rabbits. Blockage of TNF-α has already proven its efficacy in children with juvenile idiopathic arthritis not responding to standard therapy. In this paper we evaluate the effect of IA etanercept compared to subcutaneous etanercept in antigen-induced TMJ-arthritis in rabbits on histological changes using histomorphometry and stereology. This article presents the data and discussion on the anti-inflammatory effects of systemic and IA etanercept. In Part II the data on the effects of systemic and IA etanercept on facial growth are presented. Methods Forty-two rabbits (10 weeks old pre-sensitized with ovalbumin and locally induced inflammation in the temporomandibular joints were divided into three groups: a placebo group receiving IA saline injections in both joints one week after arthritis induction (n = 14, an IA etanercept group receiving 0.1 mg/kg etanercept per joint one week after arthritis induction (n = 14 and a systemic etanercept group receiving 0.8 mg/kg etanercept weekly throughout the 12-week study (n = 14. Arthritis was maintained by giving four inductions three weeks apart. Additional IA saline or etanercept injections were also given one week after the re-inductions. Histomorphometric and unbiased stereological methods (optical fractionator were used to assess and estimate the inflammation in the joints. Results The histomorphometry showed synovial proliferation in all groups. The plasma cell count obtained by the optical fractionator was significantly reduced when treating with systemic etanercept but not with IA etanercept. Semi-quantitative assessments of synovial proliferation and

  20. Comparison of intra-articular injections of Hyaluronic Acid and Corticosteroid in the treatment of Osteoarthritis of the hip in comparison with intra-articular injections of Bupivacaine. Design of a prospective, randomized, controlled study with blinding of the patients and outcome assessors

    NARCIS (Netherlands)

    Colen, S.; van den Bekerom, M.P.J.; Bellemans, J.; Mulier, M.

    2010-01-01

    Background: Although intra-articular hyaluronic acid is well established as a treatment for osteoarthritis of the knee, its use in hip osteoarthritis is not based on large randomized controlled trials. There is a need for more rigorously designed studies on hip osteoarthritis treatment as this

  1. Comparison of intra-articular injections of hyaluronic acid and corticosteroid in the treatment of osteoarthritis of the hip in comparison with intra-articular injections of bupivacaine. Design of a prospective, randomized, controlled study with blinding of the patients and outcome assessors

    NARCIS (Netherlands)

    Colen, Sascha; van den Bekerom, Michel P. J.; Bellemans, Johan; Mulier, Michiel

    2010-01-01

    Although intra-articular hyaluronic acid is well established as a treatment for osteoarthritis of the knee, its use in hip osteoarthritis is not based on large randomized controlled trials. There is a need for more rigorously designed studies on hip osteoarthritis treatment as this subject is still

  2. Anestesia em criança com síndrome de Guillain-Barré após vacina de sarampo: relato de caso Anestesia en un niño con síndrome de Guillain-Barré después de la vacuna de sarampión: relato de caso Anesthesia in Guillain-Barré pediatric patient after measles vaccination: case report

    Directory of Open Access Journals (Sweden)

    Deoclécio Tonelli

    2005-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A síndrome de Guillain-Barré após vacina de sarampo é rara. O diagnóstico muitas vezes é tardio, o que leva a um aumento da morbidade. O presente relato apresenta um caso avançado e os cuidados especiais exigidos durante a anestesia. RELATO DO CASO: Paciente do sexo masculino, com quatro anos de idade com síndrome de Guillain-Barré desde um ano de idade, foi submetido a gastrostomia sob anestesia geral sem intercorrências, com sevoflurano e sem bloqueadores neuromusculares. CONCLUSÕES: O caso ilustra a raridade etiológica de uma síndrome importante na prática anestésica assim como os eventos adversos pós-vacinação, a melhor escolha para a equipe anestésica e as complicações da síndrome de Guillain-Barré na infância.JUSTIFICATIVA Y OBJETIVOS: El síndrome de Guillain-Barré después de la vacuna de sarampión es rara. El diagnóstico en la mayoría de las veces es tardío, lo que lleva a un aumento de la morbidez. Este actual relato presenta un caso avanzado y todas las atenciones especiales exigidas durante la anestesia. RELATO DEL CASO: Paciente del sexo masculino, con cuatro años de edad con síndrome de Guillain-Barré desde hace un año de edad, fue sometido a gastrostomía bajo anestesia general sin intercurrencias, con sevoflurano y sin bloqueadores neuromusculares. CONCLUSIONES: El caso ilustra la rareza etiológica de una síndrome importante en la práctica anestésica, así como los eventos adversos pos-vacunación, la mejor elección para el equipo anestésico y las complicaciones de la síndrome de Guillain-Barré en la infancia.BACKGROUND AND OBJECTIVES: Guillain-Barré syndrome following measles vaccination is uncommon. Diagnosis is often delayed, leading to increased morbidity. This report describes an advanced Guillain-Barré case and the special approaches required during anesthesia. CASE REPORT: Male patient, four years old, with Guillain-Barré syndrome diagnosed at 1 year of

  3. Intra-articular hyaluronan is without clinical effect in knee osteoarthritis: a multicentre, randomised, placebo-controlled, double-blind study of 337 patients followed for 1 year

    DEFF Research Database (Denmark)

    Jørgensen, Anette; Stengaard-Pedersen, Kristian; Simonsen, Lars Ole

    2010-01-01

    Objective To examine the long-term efficacy and safety of five intra-articular injections with hyaluronan in knee osteoarthritis. Methods A multicentre, randomised, placebo-controlled double-blind study of 337 patients fulfilling the American College of Rheumatology (ACR) criteria for knee...... osteoarthritis (clinical and laboratory) and with a Lequesne algofunctional index score (LFI) of 10 or greater. Patients received a hyaluronan product (sodium hyaluronate; Hyalgan) (n= 167) or saline (n= 170) intra-articularly weekly for 5 weeks and were followed up to 1 year. Time to recurrence was the primary...... efficacy parameter. LFI, pain on walking 50 m based on visual analogue scale (VAS pain 50 m), paracetamol consumption, patients' global assessment, Nottingham health profile, joint effusion and number of responders were secondary efficacy parameters. The efficacy parameters were analysed by intention...

  4. Prolonged naproxen joint residence time after intra-articular injection of lipophilic solutions comprising a naproxen glycolamide ester prodrug in the rat

    DEFF Research Database (Denmark)

    Thing, Mette; Lu, Yi; Agårdh, Li

    2013-01-01

    time. Two oils, medium-chain triglycerides and castor oil, differing with respect to viscosity were tested. After intra-articular administration of oil prodrug solutions, a significant increase in the time to maximum naproxen serum concentration from around 40 to 245min, an increase in the MRTj from......Intra-articular injection of oil solutions of lipophilic prodrugs that rapidly degrade to their parent compound in synovial fluid may constitute a feasible approach to increase the joint residence time of non-steroidal anti-inflammatory drugs. In this in vivo study, oil solutions of the N......,N-diethyl glycolamide ester prodrug of naproxen (16mg/ml) were injected into the rat knee joint by dosing 6μl formulation per 100g body weight. The sustained release properties were compared to those of intra-articularly injected aqueous and oil solutions of naproxen by monitoring the naproxen serum concentrations over...

  5. The effects of intra-articular tranexamic acid given intraoperatively and intravenous tranexamic acid given preoperatively on post surgical bleeding and transfusion rate post total knee arthroplasty

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    Aryo N. Triyudanto

    2017-01-01

    Full Text Available Background: Despite the advances in the design and fixation of implants in total knee replacement (TKR. the amount of postoperative bleeding is still an important issue that has not been resolved. This study aimed to measure the effectiveness of various tranexamic acid administration.Methods: This was a randomized controlled trial study, held from August 2014 to February 2016 at Cipto Mangunkusumo Hospital, Jakarta. Twenty two patients having TKR were divided into three groups: the control group, the tranexamic acid intra-articular-intraoperative group, and the intravenous preoperative group. Intraoperative bleeding, haemoglobin (Hb level on preoperative to five-day-post-surgery, total drain production, total blood tranfusion needed and the drain removal timing were recorded and compared. Numerical data were analyzed by using parametric and non-parametric test, depended on the normality of the data.Results: The amount of blood transfusion needed in both the intra-articular group (200±SD 100 mL and the intravenous group (238±SD 53 mL were significantly different compared to those in the control group (1,016±SD 308.2 mL (p=0.001. Meanwhile, there was no significant difference between the amount of blood transfusion needed in the intra-articular group and the intravenous group. Total drain production in the intra-articular group (328±SD 193 mL and intravenous group (391±SD 185 mL was significantly different compared to the control group (652±SD 150 mL (p=0.003. No significant difference between the levels of both preoperative and postoperative haemoglobin, the amount of intraoperative bleeding, and the duration of drain usage.Conclusion: Intravenous and intra-articular tranexamic acid effectively decreased transfusion volume and drain production in patients undergoing TKR.

  6. Preliminary histopathological study of intra-articular injection of a novel highly cross-linked hyaluronic acid in a rabbit model of knee osteoarthritis.

    Science.gov (United States)

    Iannitti, Tommaso; Elhensheri, Mohamed; Bingöl, Ali O; Palmieri, Beniamino

    2013-04-01

    Osteoarthritis is a degenerative joint disease mostly occurring in the knee and commonly seen in middle-aged and elderly adults. Intra-articular injection of hyaluronic acid has been widely used for treatment of knee osteoarthritis. The aim of this study was to evaluate the efficacy of intra-articular injection of a novel highly cross-linked hyaluronic acid, alone or in combination with ropivacaine hydrochloride and triamcinolone acetonide, on knee articular cartilage in a rabbit model of collagenase-induced knee osteoarthritis. After induction of experimental osteoarthritis by intra-articular injection of collagenase, adult New Zealand white rabbits (n = 12) were divided into 3 groups. Group 1 (control group) received 0.3 ml phosphate buffered saline into the right knee joint. Group 2 received 0.3 ml cross-linked hyaluronic acid (33 mg/ml) into the right knee joint. Group 3 received a mixture of 0.15 ml cross-linked hyaluronic acid (33 mg/ml), 0.05 ml ropivacaine hydrochloride 1 % and 0.1 ml triamcinolone acetonide (10 mg/ml) into the right knee joint. Intra-articular injections were given 4 weeks after first collagenase injection and were administered once a week for 3 weeks. Gross pathology and histological evaluation of rabbits' knee joints were performed after 16 weeks following initial collagenase injection. Histological analysis of sections of right knee joints at lesion sites showed a significant decrease in Mankin's score in groups treated with hyaluronic acid alone or in combination with ropivacaine hydrochloride and triamcinolone acetonide versus control group (p hyaluronic acid, alone or in combination with ropivacaine hydrochloride and triamcinolone acetonide, produces a significant improvement in knee articular cartilage degeneration in a rabbit model of collagenase-induced osteoarthritis.

  7. Clinical and ultrasonographic features associated to response to intraarticular corticosteroid injection. A one year follow up prospective cohort study in knee osteoarthritis patient with joint effusion.

    Science.gov (United States)

    Calvet, Joan; Orellana, Cristóbal; Galisteo, Carlos; García-Manrique, María; Navarro, Noemí; Caixàs, Assumpta; Larrosa, Marta; Gratacós, Jordi

    2018-01-01

    Intraarticular injection is used for pain relief in knee osteoarthritis (OA), but there is not a well defined profile of patient who could get more benefit from it. The purpose of this study was to evaluate the frequency of pain relief at one year after corticosteroids intraarticular injection and to identify clinical factors associated to response in patients with knee osteoarthritis with joint effusion. One-year prospective cohort study of patients with knee OA with joint effusion confirmed by ultrasound. An intraarticular injection was performed following a clinical protocol. Anthropometric measurements, laboratory parameters, clinical severity, ultrasound parameters and radiological severity were collected. Response regarding pain and presence of synovial fluid on ultrasound at one month and at one year were evaluated. Clinical responder were consider in subjects with enough improvement to carry out normal daily activities with pain VAS<40mm. One hundred and thirty-two patients were included.A significant number of patients (61.4%) improved pain at one year following the protocol established in this study. Pain and ultrasound synovial fluid at one month appeared to predict the response at one year. The Lequesne index and the percentage of body fat were independently associated to pain at one year while the Lequesne index and ultrasound synovial hypertrophy were independently related to the presence of synovial fluid at one year. The status regarding pain or ultrasound synovial fluid at one month after an intraarticular joint injection appeared to predict the status at one year in patients with knee osteoarthritis and synovial effusion.

  8. Intra-articular delivery of purified mesenchymal stem cells from C57BL/6 or MRL/MpJ superhealer mice prevents post-traumatic arthritis

    OpenAIRE

    Diekman, Brian O.; Wu, Chia-Lung; Louer, Craig R.; Furman, Bridgette D.; Huebner, Janet L.; Kraus, Virginia B.; Olson, Steven A.; Guilak, Farshid

    2012-01-01

    Joint injury dramatically enhances the onset of osteoarthritis (OA) and is responsible for an estimated 12% of OA. Post-traumatic arthritis (PTA) is especially common after intraarticular fracture, and no disease-modifying therapies are currently available. We hypothesized that the delivery of mesenchymal stem cells (MSCs) would prevent PTA by altering the balance of inflammation and regeneration after fracture of the mouse knee. Additionally, we examined the hypothesis that MSCs from the MRL...

  9. Role of intra-articular corticosteroid injections in pain management during physical rehabilitation of moderate to severe cases of knee osteoarthritis

    International Nuclear Information System (INIS)

    Tasaduq, N.; Saleem, M.; Rehman, S.S.U.; Saleem, M.

    2013-01-01

    Objective: To determine the role of intra-articular corticosteroid injections in pain management during physical rehabilitation of moderate to severe cases of knee osteoarthritis. Study Design: Randomized control trial (RCT). Place and Duration of Study: Department of Rheumatology and Rehabilitation, Fauji Foundation Hospital Rawalpindi during June 2011 to February 2012. Patients and Methods: Sixty patients with moderate to severe knee osteoarthritis were randomly selected by using probability simple random sampling technique, and randomly placed into two groups A and B through flip a coin method. The intra-articular corticosteroid injections were administered into 30 patients, including 22 female and 08 male, followed by a 2 weeks physical rehabilitation program. In group B all 30 patients, 19 female and 11 male, underwent through a 2 weeks physical rehabilitation program. The visual analog scale (VAS) was used to assess the intensity of pain and was measured at the start and at completion of the 2 week treatment program. Results: There were 60 cases in the study; 30 in each treatment groups A and B, and no drop outs. Mean age of the patients in group A was 56.25 and group B it was 58.75 years. Majority of patients in both the groups were between 44 - 77 years of age. The pain intensity was calculated in group A (p-value=0.007) and group B (p-value=0.009) at baseline. The patients in group A was treated by intra-articular corticosteroid injections followed by physical rehabilitation and group B was treated only with physical rehabilitation for two months. The pain intensity was measured at the completion of treatment for group A (p - value = 0.006) and B (p - value 0.271). Conclusion: The study concluded that intra-articular corticosteroid injections combined with physical therapy management are more effective in pain management during physical rehabilitation of moderate to severe cases of knee osteoarthritis as compare with physical therapy alone. (author)

  10. Anestesia para colecistectomia videolaparoscópica em paciente portador de Doença de Steinert: relato de caso e revisão de literatura Anestesia para colecistectomía videolaparoscópica en oaciente oortador de Enfermedad de Steinert: relato de caso y revisión de la literatura Anesthesia for videolaparoscopic cholecystectomy in a patient with Steinert Disease: case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Flora Margarida Barra Bisinotto

    2010-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: As distrofias miotônicas são doenças neuromusculares de transmissão autossômica dominante. Dentre elas, a distrofia miotônica tipo 1 (DM1, ou doença de Steinert, é a mais comum no adulto e, além do envolvimento muscular, apresenta manifestações sistêmicas importantes. A DM1 representa um desafio para o anestesiologista. Os pacientes apresentam maior sensibilidade às drogas anestésicas e complicações, principalmente cardíacas e pulmonares. Além disso, há a possibilidade de apresentarem hipertermia maligna e crise miotônica. Descreveu-se o caso de um paciente que teve complicação pulmonar importante após ser submetido à anestesia geral. RELATO DO CASO: Paciente de 39 anos, portador de DM1, foi submetido à anestesia geral para colecistectomia videolaparoscópica. A anestesia foi venosa total com propofol e remifentanil e rocurônio. O procedimento cirúrgico de 90 minutos não apresentou intercorrências, mas após a extubação o paciente apresentou insuficiência respiratória e crise miotônica, que tornou a intubação traqueal impossível. Utilizou-se a máscara laríngea, que possibilitou a oxigenação adequada, e a ventilação mecânica foi mantida até a recuperação total da atividade respiratória. Evolução ocorreu sem outras complicações. CONCLUSÕES: A DM1 é uma doença que apresenta várias peculiaridades para o anestesiologista. O conhecimento minucioso do seu envolvimento sistêmico, associado à ação diferenciada das drogas anestésicas nesses pacientes, proporcionará um ato anestésicocirúrgico mais seguro.JUSTIFICATIVA Y OBJETIVOS: Las distrofias miotónicas son enfermedades neuromusculares de transmisión autosómica dominante. Entre ellas está la distrofia miotónica tipo 1 (DM1, o enfermedad de Steinert, que es la más común en el adulto y además de la involucración muscular, presenta manifestaciones sistémicas importantes. La DM1 representa un reto para el

  11. Combination therapy with intra-articular injection of mesenchymal stem cells and articulated joint distraction for repair of a chronic osteochondral defect in the rabbit.

    Science.gov (United States)

    Harada, Yohei; Nakasa, Tomoyuki; Mahmoud, Elhussein Elbadry; Kamei, Goki; Adachi, Nobuo; Deie, Masataka; Ochi, Mitsuo

    2015-10-01

    The present study investigated intra-articular injection of bone-marrow-derived mesenchymal stem cells (MSCs) combined with articulated joint distraction as treatment for osteochondral defects. Large osteochondral defects were created in the weight-bearing area of the medial femoral condyle in rabbit knees. Four weeks after defect creation, rabbits were divided into six groups: control group, MSC group, distraction group, distraction + MSC group, temporary distraction group, and temporary distraction + MSC group. Groups with MSC received intra-articular injection of MSCs. Groups with distraction underwent articulated distraction arthroplasty. Groups with temporary distraction discontinued the distraction after 4 weeks. The rabbits were euthanized at 4, 8, and 12 weeks after treatment except temporary distraction groups which were euthanized at only 12 weeks. Histological scores in the distraction + MSC group were significantly better than in the control, MSC group or distraction group at 4 and 8 weeks, but showed no further improvement. At 12 weeks, the temporary distraction + MSC group showed the best results, demonstrating hyaline cartilage repair with regeneration of the osteochondral junction. In conclusion, joint distraction with intra-articular injection of MSCs promotes early cartilage repair, and compressive loading of the repair tissue after temporary distraction stimulates articular cartilage regeneration. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  12. Intra-articular injection of tranexamic acid via a drain plus drain-clamping to reduce blood loss in cementless total knee arthroplasty

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    Mutsuzaki Hirotaka

    2012-09-01

    Full Text Available Abstract Background Patients undergoing cementless total knee arthroplasty (TKA sometimes suffer large blood loss. In a retrospective study, we explored whether postoperative intra-articular retrograde injection of tranexamic acid (TA and leaving a drain clamp in place for 1 h reduced blood loss. Patients and methods Patients (n = 140 treated with unilateral primary cementless TKA (posterior cruciate ligament retained were divided into two groups: those who had an intra-articular injection of TA (1000 mg and drain clamping for 1 h postoperatively (study group, n = 70 and those who were not given TA and did not undergo clamping of their drains (control group, n = 70. Postoperative total blood loss, volume of drainage, hemoglobin level, transfusion amounts and rates, D-dimer level at postoperative day (POD 7, and complications were recorded. Results Total blood loss, total drainage, mean transfusion volume, and transfusion rates were lower in the study group than in controls (P P P  Conclusions Immediately postoperative intra-articular retrograde injection of TA and 1 h of drain-clamping effectively reduced blood loss and blood transfusion after cementless TKA. We believe that this method is simple, easy, and suitable for these patients.

  13. Intra-articular steroid injection for osteoarthritis of the hip prior to total hip arthroplasty : is it safe? a systematic review.

    Science.gov (United States)

    Pereira, L C; Kerr, J; Jolles, B M

    2016-08-01

    Using a systematic review, we investigated whether there is an increased risk of post-operative infection in patients who have received an intra-articular corticosteroid injection to the hip for osteoarthritis prior to total hip arthroplasty (THA). Studies dealing with an intra-articular corticosteroid injection to the hip and infection following subsequent THA were identified from databases for the period between 1990 to 2013. Retrieved articles were independently assessed for their methodological quality. A total of nine studies met the inclusion criteria. Two recommended against a steroid injection prior to THA and seven found no risk with an injection. No prospective controlled trials were identified. Most studies were retrospective. Lack of information about the methodology was a consistent flaw. The literature in this area is scarce and the evidence is weak. Most studies were retrospective, and confounding factors were poorly defined or not addressed. There is thus currently insufficient evidence to conclude that an intra-articular corticosteroid injection administered prior to THA increases the rate of infection. High quality, multicentre randomised trials are needed to address this issue. Cite this article: Bone Joint J 2016;98-B:1027-35. ©2016 The British Editorial Society of Bone & Joint Surgery.

  14. Single-dose intra-articular bupivacaine plus morphine versus bupivacaine alone after arthroscopic knee surgery: a meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Yang, Ye; Zeng, Chao; Wei, Jie; Li, Hui; Yang, Tuo; Deng, Zhen-Han; Li, Yu-Sheng; Yang, Tu-Bao; Lei, Guang-Hua

    2017-03-01

    The purpose of this meta-analysis was to compare the efficacy and safety of single-dose intra-articular bupivacaine plus morphine versus bupivacaine alone for pain management following arthroscopic knee surgery. A comprehensive literature search was conducted to identify randomized controlled trials that used single-dose intra-articular bupivacaine plus morphine and bupivacaine alone for post-operative pain, using MEDLINE (1966-2014), Cochrane Library and EMBASE databases. The weighted mean difference (WMD), relative risk (RR) and their corresponding 95 % confidence intervals (CIs) were calculated using RevMan statistical software. A total of twenty-nine trials (n = 1167) were included. The post-operative visual analog scale (VAS) pain score of the bupivacaine plus morphine group compared with the bupivacaine alone group was significantly lower (WMD -1.15, 95 % CI -1.67 to -0.63, p bupivacaine plus morphine was shown to be significantly better than bupivacaine alone at relieving post-operative pain after arthroscopic knee surgery without increasing the short-term side effects. Routine use of single-dose intra-articular bupivacaine plus morphine is an effective way for pain management after arthroscopic knee surgery. II.

  15. Are intra-articular corticosteroid injections better than conventional TENS in treatment of rotator cuff tendinitis in the short run? A randomized study.

    Science.gov (United States)

    Eyigor, C; Eyigor, S; Kivilcim Korkmaz, O

    2010-09-01

    Rotator cuff problems are common causes of pain and restriction of movement in shoulder. The aim of this study to compare the effect of intra-articular injection of corticosteroid and conventional transcutaneous electrical nerve stimulator (TENS) treatment in treatment of rotator cuff tendinitis. Subjects were randomly allocated into Group 1 (intra-articular injection of corticosteroid) and Group 2 (conventional transcutaneous electrical nerve stimulation-TENS). Outcome measurements were performed using the Visual Analogue Scale (VAS) for pain, range of motion (ROM), the Shoulder Disability Questionnaire (SDQ), the Short Form-36 (SF-36), and Beck Depression Scale (BDS) questionnaires and paracetamol consumption. In both groups, significant improvement was observed in all weeks in VAS, ROM and SDQ scores (P0.05). In both treatment groups, paracetamol consumption decreased in time (Protator cuff tendinitis. When two treatments are compared, it may be concluded that intra-articular steroid injection was more effective especially in the first weeks regarding pain, ROM and disability. Otherwise, use of TENS allow to patients to increase activity level, improve function and quality of life like that in our study. TENS, as it is cheaper, non-invasive, more easily performed and efficient, may be preferable for the treatment of shoulder pain. Further studies are needed to include these results in the prospective treatment guidelines.

  16. Intra-Articular Injection of Human Meniscus Stem/Progenitor Cells Promotes Meniscus Regeneration and Ameliorates Osteoarthritis Through Stromal Cell-Derived Factor-1/CXCR4-Mediated Homing

    Science.gov (United States)

    Shen, Weiliang; Chen, Jialin; Zhu, Ting; Chen, Longkun; Zhang, Wei; Fang, Zhi; Heng, Boon Chin; Yin, Zi; Chen, Xiao; Ji, Junfeng

    2014-01-01

    Meniscus injury is frequently encountered in clinical practice. Current surgical therapy involving partial or complete meniscectomy relieves pain in the short-term but often leads to osteoarthritis (OA) in the long-term. In this study, we report a new strategy of articular cartilage protection by intra-articular injection of novel human meniscus stem/progenitor cells (hMeSPCs). We found that hMeSPCs displayed both mesenchymal stem cell characteristics and high expression levels of collagen II. In the rat meniscus injury model, hMeSPC transplantation not only led to more neo-tissue formation and better-defined shape but also resulted in more rounded cells and matured extracellular matrix. Stromal cell-derived factor-1 (SDF-1) enhanced the migration of hMeSPCs, whereas AMD3100 abolished the chemotactic effects of SDF-1 on hMeSPCs, both in vitro and in vivo. In an experimental OA model, transplantation of hMeSPCs effectively protected articular cartilage, as evidenced by reduced expression of OA markers such as collagen I, collagen X, and hypoxia-inducible factor 2α but increased expression of collagen II. Our study demonstrated for the first time that intra-articular injection of hMeSPCs enhanced meniscus regeneration through the SDF-1/CXCR4 axis. Our study highlights a new strategy of intra-articular injection of hMeSPCs for meniscus regeneration. PMID:24448516

  17. Intraarticular Facet Injections for Low Back Pain: Design Considerations, Consensus Methodology to Develop the Protocol for a Randomized Controlled Trial.

    Science.gov (United States)

    Mars, Tom; Ellard, David R; Antrobus, James H L; Cairns, Melinda; Underwood, Martin; Haywood, Kirstie; Keohane, Susie; Sandhu, Harbinder; Griffiths, Frances

    2015-01-01

    Since the publication of guidelines by the UK National Institute for Health and Care Excellence (NICE) and the American Pain Society guidelines for low back pain in 2009 there have been deep divisions in the pain treatment community about the use of therapeutic intraarticular facet joint injections. While evidence for the effectiveness or not of intraarticular facet joint injections remains sparse, uncertainty will remain. The Warwick feasibility study, along with a concurrent study with a different design led by another group, aims to provide a stable platform from which the effectiveness and cost effectiveness of intraarticular facet joint injections added to normal care could be evaluated in randomized controlled trials (RCTs). To reach consensus on key design considerations for the Warwick facet feasibility study from which the study protocol and working manuals will be developed. A consensus conference involving expert professionals and lay members. Preliminary work identified 5 key design considerations for deliberation at our consensus conference. Three concerned patient assessment and treatment: diagnosis of possible facet joint pain, interaarticular facet joint injection technique, and best usual care. Two concerned trial analysis: a priori sub-groups and minimally important difference and are reported elsewhere. We did systematic evidence reviews of the design considerations and summarized the evidence. Our design questions and evidence summaries were distributed to all delegates. This formed the basis for discussions on the day. Clinical experts in all aspects of facet joint injection from across the UK along with lay people were invited via relevant organizations. Nominal group technique was used in 15 facilitated initial small group discussions. Further discussion and ranking was undertaken in plenary. All small group and plenary results were recorded and checked and verified post conference. Where necessary participants were contacted via email to

  18. Do intra-articular hyaluronic acid injections delay total knee replacement in patients with osteoarthritis – A Cox model analysis

    Science.gov (United States)

    Amor, Bernard; Bardoulat, Isabelle; Tetafort, Aymeric; Pelletier-Fleury, Nathalie

    2017-01-01

    Due to the growing worldwide prevalence of knee osteoarthritis, the optimal management of this issue is critical for reducing its burden. Objectives This study aimed to describe patients treated for knee osteoarthritis between 2006 and 2013 in France and to compare the delay from diagnosis to total knee replacement between patients who received intra-articular hyaluronic acid injections and those who did not receive the injections. A second objective was to compare direct medical costs for ambulatory care between treatment groups. Materials and methods Patients were selected from a representative sample of the real world administrative claims database using an algorithm developed by experts from the scientific committee of the study. Data were matched with the medico-administrative database for hospital care. A Cox proportional hazards model was stratified for the treatment group and adjusted for available socio-demographic and medical covariates to compare restricted mean survival times at different time points (1, 3, 5 and 7.5 years) between groups. Costs were expressed in 2013 euros. Results A total of 14,782 patients were treated for knee osteoarthritis (67% women; mean age = 68 years). Among this population, 1,662 patients had total knee replacement (11.2%). At each time point, restricted mean survival time without total knee replacement was significantly higher (p-valueshyaluronic acid group, from +51 to +217 days at 1 and 7.5 years, respectively. For the year preceding total knee replacement, the means for total direct medical costs were similar between groups, €744 vs €805 for treatment and control groups, respectively, (p-value = 0.104). Intra-articular injections accounted for less than 10% of the total costs. Conclusion This is the first retrospective longitudinal study involving knee osteoarthritis patients using medico-administrative databases in France. The results support the effectiveness of hyaluronic acid injections in delaying total knee

  19. Effects of intra-articular hyaluronic acid injection on immunohistochemical characterization of joint afferents in a rat model of knee osteoarthritis.

    Science.gov (United States)

    Ikeuchi, M; Izumi, M; Aso, K; Sugimura, N; Kato, T; Tani, T

    2015-03-01

    Intra-articular hyaluronic acid (HA) injection, known as viscosupplementation, is a widely used therapy for pain relief in knee osteoarthritis (OA). Long-term clinical efficacy of HA has been reported in spite of a relatively short residence time. Herein, we evaluated our hypothesis that intra-articular HA injection could reduce the OA-associated changes in joint afferents. OA was induced by intra-articular injection of mono-iodoacetate in rats. Animals in the OA + HA group were given three weekly intra-articular HA injections. Pain-related behaviours, including weight-bearing asymmetry and mechanical hyperalgesia of the paw, knee joint histology and immunohistochemistry of joint afferents identified by retrograde labelling, were compared between groups (naïve, OA and OA + HA). OA rats showed pain-related behaviours and up-regulation of pain-related neurochemical markers [calcitonin gene-related peptide (CGRP), tyrosine receptor kinase A (TrkA) and acid-sensing ion channel 3 (ASIC3)] in joint afferents. HA injections reduced not only the severity of OA and pain behaviours but also OA-associated neurochemical changes in joint afferents. The differences between OA and OA + HA were statistically significant in CGRP (61 ± 10% vs. 51 ± 10%; p = 0.0406) but not significant in TrkA (62 ± 10% vs. 54 ± 9%; p = 0.0878) and ASIC3 (38 ± 9% vs. 32 ± 8%; p = 0.3681). Intra-articular HA injections reduced the severity of OA, decreased mechanical hyperalgesia of the paw, but not weight-bearing asymmetry, and attenuated OA-associated up-regulation of CGRP, but not TrkA and ASIC3, in joint afferents. The modulatory effects of HA on joint afferents is one of the underlying mechanisms of the gap between HA residence time and duration of clinical efficacy. © 2014 European Pain Federation - EFIC®

  20. Importância do treinamento de residentes em eventos adversos durante anestesia: experiência com o uso do simulador computadorizado Importancia del entrenamiento de los practicantes (médicos en ejercicio en eventos adversos durante la anestesia: experiencia con el uso del simulador computadorizado Importance of critical events training for anesthesiology residents: experience with computer simulator

    Directory of Open Access Journals (Sweden)

    Domingos Dias Cicarelli

    2005-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Em decorrência da grande evolução da monitorização e do arsenal terapêutico disponível nos últimos anos, houve uma redução na incidência de eventos adversos durante procedimentos anestésicos. Porém, continua importante o treinamento dos médicos residentes para este tipo de ocorrência. O objetivo deste estudo foi avaliar o desempenho prático do residente de Anestesiologia em eventos adversos durante uma anestesia simulada. MÉTODO: Foram avaliados 17 médicos em especialização do primeiro e segundo anos de Anestesiologia (ME1 e ME2 e 5 instrutores do Centro de Ensino e Treinamento (CET do HCFMUSP (Título Superior em Anestesiologia - TSA. Foi utilizado o simulador computadorizado Anesthesia Simulator Consultant (ASC versão 2.0 - 1995/Anesoft para realização das simulações dos eventos. Os incidentes críticos escolhidos foram fibrilação ventricular (FV e choque anafilático. Após a realização da simulação, foram impressos os resultados de cada participante e avaliadas e pontuadas as condutas adotadas para resolver os incidentes críticos pré-determinados. Os participantes avaliaram o simulador através do preenchimento de um questionário. RESULTADOS: Não houve diferença estatística entre as médias obtidas pelos grupos, porém notou-se uma tendência de melhor desempenho dos grupos TSA e ME2 na simulação de FV. Com relação ao choque anafilático, houve uma tendência de melhor desempenho do grupo TSA. CONCLUSÕES: O treinamento para diagnóstico e condutas em eventos adversos deve ser foco de atenção durante o treinamento de médicos residentes e na atualização de anestesiologistas. O uso do simulador pode ser uma das formas de realizar o treinamento nestas situações.JUSTIFICATIVA Y OBJETIVOS: Con la decurrencia de la grande evolución de la monitorización y del arsenal terapéutico disponible en los últimos años, hubo una reducción en la incidencia de eventos adversos

  1. Tratamento do laringoespasmo em anestesia pediátrica por digitopressão retroauricular: relato de casos Tratamiento del laringoespasmo en anestesia pediátrica por digitopresión retroauricular: relato de casos Treatment of laryngeal spasm in pediatric anesthesia by retroauricular digital pressure: case report

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    Raquel Reis Soares

    2008-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Os problemas com a via aérea pediátrica estão entre os maiores desafios que o anestesiologista pode encontrar em sua prática clínica. Dentre eles, destaca-se o laringoespasmo, que ocorre com freqüência duas a três vezes maior na população pediátrica. O objetivo deste trabalho foi relatar o tratamento de laringoespasmo realizado com digitopressão de ponto localizado atrás do lóbulo da orelha. A técnica é fácil, antiga, porém pouco divulgada. Pode ser utilizada de forma segura e rápida, dispensando o acesso venoso periférico que, em algumas situações, pode estar ausente. RELATO DOS CASOS: Dois casos de anestesia pediátrica em pacientes de 3 anos e de 6 meses de idade, nos quais ocorreu laringoespasmo. Ambos foram tratados apenas com a digitopressão da depressão retroauricular e evoluíram com pronta melhora do padrão respiratório e da saturação arterial de oxigênio. Como o laringoespasmo é complicação comum e potencialmente grave pela sua morbimortalidade, é necessário tratamento seguro, eficaz e rápido. CONCLUSÃO: O tratamento clássico do laringoespasmo é a administração de oxigênio a 100% com pressão positiva por unidade ventilatória (balão e máscara e, se não houver resposta, administração venosa de 0,25 a 1 mg.kg-1 de succinilcolina. A técnica apresentada para tratamento do laringoespasmo é fácil, segura e eficaz, e realizada com digitopressão bilateral da região localizada atrás do lóbulo das orelhas. O laringoespasmo cedeu em poucos segundos e os pacientes tiveram evolução favorável.JUSTIFICATIVA Y OBJETIVOS: Los problemas con la vía aérea pediátrica están entre los más grandes retos que el anestesiólogo puede encontrar en su práctica clínica. Entre ellos se destaca el laringoespasmo, que ocurre con frecuencia de dos a tres veces más en la población pediátrica. El objetivo de este trabajo fue relatar el tratamiento de laringoespasmo realizado con

  2. Efficacy in the use of local anesthesia in patients with surgical intervention for the resolution of anorectal pathologies

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    Victoria Dowling

    2018-01-01

    Full Text Available A prospective, comparative, longitudinal study was conducted in the period from April 2016 to January 2017 in order to determine the efficacy of local anesthesia for the surgical resolution of anorectal pathologies in surgically operated patients who attended the General University Hospital “Luis Gomez Lopez. Thus, the population was composed of patients with anorectal pathologies of low complexity, with no previous anorectal surgical history (Hemorrhoids, anal fissure, perianal fistula, hypertrophic anal papilla, perianal condyloma acuminata, which were agreed to be included in this study, without contraindications for use of local anesthesia. A non-probabilistic, intentional sample was made up of 30 patients and the anesthetic protocol was administered following an anesthetic protocol of perianal local anesthesia using anesthetic mixture (70% of 2% lidocaine + 30% of 0.5% bupivacaine quantifying pain tolerance during the intraoperative period on the first and fifth postoperative days, as well as any adverse effects. The results were expressed in absolute numbers and percentages; a good tolerance to pain was observed with some differences related to the sex of the individuals studied; no complications were observed. Resumo: Esse estudo prospectivo, comparativo e longitudinal foi realizado no período de abril de 2016 a janeiro de 2017, com o objetivo de determinar a eficácia da anestesia local para resolução cirúrgica de patologias anorretais em pacientes cirurgicamente operados que compareceram no Hospital Geral Universitário Luis Gomez Lopes. Essa população se compunha de pacientes com patologias anorretais de baixa complexidade, sem história prévia de cirurgia anorretal (hemorroidas, fissura anal, fístula perianal, papila anal hipertrófica, condiloma acuminado perianal, com prévia concordância em participar no presente estudo e sem contraindicações para o uso de anestesia local. Foi obtida uma amostra intencional e n

  3. Kinetics features changes before and after intra-articular hyaluronic acid injections in patients with knee osteoarthritis.

    Science.gov (United States)

    Tang, Alice Chu-Wen; Tang, Simon Fuk-Tan; Hong, Wei-Hsien; Chen, Hsieh-Ching

    2015-02-01

    To examine the kinetic features in patients with knee osteoarthritis (OA) after intra-articular hyaluronic acid (IAHA) injections in different time periods. A single group repeated measures study. Gait laboratory in a tertiary hospital. Twenty-five subjects with bilateral symptomatic knee OA and 15 healthy control subjects. Gait analyses were performed in both control and OA groups before (baseline), and after the completion of IAHA injections (1 week, 3 months, and 6 months). Knee pain and functional indices were assessed using a visual analogue scale (VAS) and the Lequesne function Index (LI). Joint kinetic changes were analyzed in the frontal and sagittal planes with 6-camera motion analysis system and two AMTI force plates. VAS and LI scores were both improved in OA group after IAHA injections (pinjections (pinjections can provide significant pain relief and improvement in activity of daily living function for patients with knee OA. However, the reduction in pain and the increase in knee adduction moment may last up to 6 months. This may cause excessive loading on the knee joints, which may further accelerate the rate of knee degeneration. As a result, longer study time is needed to determine whether the observed kinetic findings in this study are associated with detrimental outcomes on the knee joints. © 2015 Elsevier B.V. All rights reserved.

  4. The safety of intra-articular injections for the treatment of knee osteoarthritis: a critical narrative review.

    Science.gov (United States)

    Nguyen, Christelle; Rannou, François

    2017-08-01

    International guidelines recommend that the management of knee osteoarthritis (OA) combine both nonpharmacological and pharmacological interventions. Intra-articular (IA) therapies are considered part of this multimodal approach and are well-established Food and Drug Administration (FDA) and European Medicines Agency (EMA)-approved treatments. Areas covered: Safety data for knee OA, including IA corticosteroids, hyaluronic acid, platelet-rich plasma and botulinum toxin are critically reviewed, and evidence- and pratice-based measures to improve safety of IA therapies are discussed. Expert opinion: The incidence of AEs attributable to IA therapies across clinical trials in knee OA is very low, and barely reaches significance when compared to the incidence of AEs in the comparator group. These events are exceptionally serious. Mild differences between products have been inconsistently reported mainly for IA HA. One can distinguish self-limited AEs such as post-injection pain and swelling that are the most frequently reported AEs, from AEs that are not self-limited but rare such as septic arthritis. The safety of IA therapies can be improved by applying simple measures designed to prevent AEs. However, even though no specific safety concerns have been raised to date about IA therapies, the quality of evidence is low, and there is a need to improve the monitoring and reporting of safety data from clinical trials and post-marketing surveillance.

  5. Radiographical measurements for distal intra-articular fractures of the radius using plain radiographs and cone beam computed tomography images

    Energy Technology Data Exchange (ETDEWEB)

    Suojaervi, Nora; Lindfors, N. [Helsinki University Central Hospital, Department of Hand Surgery, Helsinki (Finland); Sillat, T.; Koskinen, S.K. [HUS Helsinki Medical Imaging Center, Helsinki University Central Hospital, Department of Radiology, Helsinki (Finland)

    2015-12-15

    Operative treatment of an intra-articular distal radius fracture is one of the most common procedures in orthopedic and hand surgery. The intra- and interobserver agreement of common radiographical measurements of these fractures using cone beam computed tomography (CBCT) and plain radiographs were evaluated. Thirty-seven patients undergoing open reduction and volar fixation for a distal radius fracture were studied. Two radiologists analyzed the preoperative radiographs and CBCT images. Agreement of the measurements was subjected to intra-class correlation coefficient and the Bland-Altman analyses. Plain radiographs provided a slightly poorer level of agreement. For fracture diastasis, excellent intraobserver agreement was achieved for radiographs and good or excellent agreement for CBCT, compared to poor interobserver agreement (ICC 0.334) for radiographs and good interobserver agreement (ICC 0.621) for CBCT images. The Bland-Altman analyses indicated a small mean difference between the measurements but rather large variation using both imaging methods, especially in angular measurements. For most of the measurements, radiographs do well, and may be used in clinical practice. Two different measurements by the same reader or by two different readers can lead to different decisions, and therefore a standardization of the measurements is imperative. More detailed analysis of articular surface needs cross-sectional imaging modalities. (orig.)

  6. Intra-articular versus intravenous tranexamic acid application in total knee arthroplasty: a meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Mi, Bobin; Liu, Guohui; Zhou, Wu; Lv, Huijuan; Liu, Yi; Zha, Kun; Wu, Qipeng; Liu, Jing

    2017-07-01

    The purpose of this meta-analysis was to compare the blood loss and complications of intra-articular (IA) with intravenous (IV) tranexamic acid (TXA) for total knee arthroplasty (TKA). A comprehensive search of studies was conducted to identify related articles in Pubmed, Embase, Cochrane central Register of Controlled Trials, springerLink, OVID and the Research published from January 1980 to September 2016. All studies that compared IA TXA with IV TXA application on TKA were included. Main outcomes of the two methods were collected and analyzed by using Review Manager 5.3. There were 16 randomized controlled trials with 1308 cases met the criteria. Compared with IV TXA, IA TXA had similar blood volume of drainage, hidden blood loss, transfusion rate and complications (P > 0.05). IA TXA had lower total blood loss than IV TXA, and there was significant difference (P  0.05) when compared with IA TXA. Both IA TXA and single dose of IV TXA are effective in reducing total blood loss and postoperative hemoglobin drop without increasing complications of DVT or PE. The current meta-analysis suggests that 1.5 g TXA by IA administration or 1 g TXA by IV administration 10 min before tourniquet deflation is effective and safe in patients undergoing TKA.

  7. Intra-articular Administration of Chitosan Thermosensitive In Situ Hydrogels Combined With Diclofenac Sodium-Loaded Alginate Microspheres.

    Science.gov (United States)

    Qi, Xiaole; Qin, Xiaoxue; Yang, Rong; Qin, Jiayi; Li, Wenyan; Luan, Kun; Wu, Zhenghong; Song, Li

    2016-01-01

    The aims of this study were to prepare fine intra-articular-administrated chitosan thermosensitive hydrogels combined with alginate microspheres and to investigate the possibility of those hydrogels as a drug delivery system for promoting the anti-inflammation effect. Diclofenac sodium containing alginate microspheres was prepared by a modified emulsification and/or gelation method and then dispersed into injectable thermosensitive hydrogels, consisting of chitosan and β-glycerophosphate. The final combined hydrogels were evaluated in terms of their morphology properties, rheological properties, in vitro drug release, and in vivo biocompatibility and pharmacodynamics behaviors. The optimized formulation exhibited sol-gel transition at 31.72 ± 0.42°C and quickly turned into gel within 5 min, with sustained drug release characteristics followed Ritger-Peppas equation, which could prolong the in vitro drug release to 5 days. In addition, the anti-inflammation efficacy of the combined hydrogels in rabbits with experimental rheumatoid arthritis was higher than that of drug solution and pure chitosan hydrogels. Those results demonstrated that these combined hydrogels could become a potential drug delivery system for improving the therapeutic effect of diclofenac sodium and suggested an important technology platform for intra-articular administration. Copyright © 2016 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

  8. Leflunomide biodegradable microspheres intended for intra-articular administration: Development, anti-inflammatory activity and histopathological studies.

    Science.gov (United States)

    El-Setouhy, Doaa Ahmed; Abdelmalak, Nevine Shawky; Anis, Shady E; Louis, Dina

    2015-11-30

    Leflunomide, the disease-modifying anti-rheumatic drug was formulated as microspheres for prolonged drug release in the form of intraarticular injection. Eight formulations were developed using three biodegradable PDLG polymers (lactide/glycolide copolymer) and polycaprolactone (PLC) at two drug:polymer ratios (1:2 and 1:4). Solvent evaporation method was employed using polyvinyl alcohol or hydropxypropyl methylcellulose as stabilizers. Formulations were assessed for encapsulation efficiency, yield, particle size, release pattern and SEM. F6 (PDLG 5010), with appropriate particle size and prolonged drug release, was chosen for in-vivo studies using arthritis induced rats, which were intrarticularly injected with F6 or took oral Avara(®). Nuclear factor-kappa B measurements and histopathologic studies were conducted. There was significant reduction of inflammation caused by both F6 and oral Avara(®). Histopathologic studies showed minimal infiltration by chronic inflammatory cells and no angiogenesis in F6 compared to Avara(®). Results also revealed biocompatibility of the polymer used. Copyright © 2015 Elsevier B.V. All rights reserved.

  9. Intraarticular Sacroiliac Joint Injection Under Computed Tomography Fluoroscopic Guidance: A Technical Note to Reduce Procedural Time and Radiation Dose

    International Nuclear Information System (INIS)

    Paik, Nam Chull

    2016-01-01

    PurposeA technique for computed tomography fluoroscopy (CTF)-guided intraarticular (IA) sacroiliac joint (SIJ) injection was devised to limit procedural time and radiation dose.MethodsOur Institutional Review Board approved this retrospective analysis and waived the requirement for informed consent. Overall, 36 consecutive diagnostic or therapeutic IA SIJ injections (unilateral, 20; bilateral, 16) performed in 34 patients (female, 18; male, 16) with a mean age of 45.5 years (range 20–76 years) under CTF guidance were analyzed, assessing technical success (i.e., IA contrast spread), procedural time, and radiation dose.ResultsAll injections were successful from a technical perspective and were free of serious complications. Respective median procedural times and effective doses of SIJ injection were as follows: unilateral, 5.28 min (range 3.58–8.00 min) and 0.11 millisievert (mSv; range 0.07–0.24 mSv); and bilateral, 6.72 min (range 4.17–21.17 min) and 0.11 mSv (range 0.09–0.51 mSv).ConclusionsGiven the high rate of technical success achieved in limited time duration and with little radiation exposure, CTF-guided IA SIJ injection is a practical and low-risk procedure.

  10. Intra-articular Entrapment of Medial Epicondyle Fracture Fragment in Elbow Joint Dislocation Causing Ulnar Neuropraxia: A Case Report

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    Syed J

    2017-03-01

    Full Text Available Traumatic elbow dislocations in children are rare but most of them are complex dislocations, and in such dislocations, medial humerus epicondyle fractureis the most common associated injury. Fracture incarceration in the elbow joint occurs in 5-18% of medial humerus epicondyle fractures but ulnar neuropraxia is very rare. Open reduction internal fixation is indicated in medial humerus epicondyle fracture with fracture incarceration, ulnar neuropraxia, marked instability or open fracture. Operative treatment options include fragment excision and sutures, closed or open reduction and Kirschner wire fixation, open reduction and suture fixation, open reduction and smooth pin fixation, and open reduction and screw fixation. However, ulnar nerve transposition is debatable as good outcome had been reported with and without nerve transposition. We report a case of a 13-year old boy, who presented with right elbow dislocation and intra-articular entrapment of medial humerus epicondyle fracture fragment, complicated with sensory ulnar neuropraxia, following a fall onto his right outstretched hand in a motor vehicle accident. The elbow joint was reduced using close manipulative reduction but the fracture fragment remained entrapped post-reduction. The patient then underwent open reduction and screw fixation of the medial humerus epicondyle fracture without ulnar nerve transposition. He had good functional outcome six weeks after surgical intervention, with complete recovery of ulnar neuropraxia six months later. Currently, he is doing well at school and is active with his sporting activity.

  11. Intra-articular calcaneal fractures: effect of open reduction and internal fixation on the contact characteristics of the subtalar joint.

    Science.gov (United States)

    Mulcahy, D M; McCormack, D M; Stephens, M M

    1998-12-01

    Intra-articular calcaneal fractures